[Pott's Puffy Tumor: a need for interdisciplinary diagnosis and treatment. German Version]. / Pott-Puffy-Tumor: die Notwendigkeit einer interdisziplinären Diagnostik und Behandlung.

Pott's puffy tumor (PPT) is an infection of the frontal sinus with subperiosteal and intracranial abscess formation and one of the rare entities in pediatrics. We present a series of four cases of PPT that occurred in two children (6 and 9 years) and in two young adults (17 and 19 years). All patients were treated by an interdisciplinary team of pediatric, neurosurgical, ENT, radiological, and neuroradiological specialists. Antibiotic treatment was combined with single endoscopic surgery in one case and combined endoscopic sinus surgery with an open transcranial approach to drain intracranial abscess formation in three cases. It is important to be aware that PPT occurs in children with the finding of intracranial abscess formation. Therefore, a close interdisciplinary cooperation for successful treatment is needed in this rare disease.

Orbital cellulitis, sinusitis and intracranial abnormalities in two adolescents with COVID-19.

We review two cases of adolescents with orbital cellulitis, sinusitis and SARS- CoV-2 infection presenting to emergency departments within a 24 hour period. SARS-CoV-2 samples obtained within 24 hours were positive, supporting prior infection despite relatively limited early symptoms of COVID-19. Unusual clinical and radiographic characteristics included hemorrhagic abscess with blood of varying age in the first, intracranial epidural abscess in the second, radiographic signal consistent with hemorrhagic or thrombotic phenomena, retro-maxillary antral fat changes, and meningeal enhancement or extension in both cases. Radiographic findings thereby mimic fungal infection, although final cultures and ancillary investigation for allergic and invasive fungal disease have remained negative. These cases highlight two unusual orbital presentations of cellulitis occurring in the context of SARS-CoV-2 co-infection.

Patient presenting with frontal subperiosteal abscess and headache: a case of Pott's puffy tumour.

Chronic sinusitis can be complicated with erosion of anterior or posterior wall of the sinus; causing Pott's puffy tumour in the anterior, or epidural abscess in the posterior communication. A 65-year old man with a painful swelling in his forehead is presented. Pott's puffy tumour was diagnosed. CT, MRI, and DTI studies were obtained. Epidural or dural involvement was not present. In the first operation, anterior wall of the frontal sinus wall was opened. Osteomyelitis debridement was performed and the frontonasal duct was enlarged endoscopically. Antibiotics were commenced and were continued for 6 weeks. In the second operation, nasal septum deviation was fixed. Postoperative course was uneventful. The presented case suggests that treatment of sinus osteomyelitis should comprise immediate surgical drainage and osteomyelitis debridement followed by long-term administration of antibiotics. MRI study with contrast should be obtained to rule out epidural abscess and dural infiltration.

Arcanobacterium hemolyticum orbital cellulitis: a rare but aggressive disease.

The clinical presentation and course of orbital cellulitis in a young adult resulting from Arcanobacterium hemolyticum frontal sinusitis are presented in detail. This case illustrates the importance of a multidisciplinary approach for refractory and aggressive orbital cellulitis. A high level of suspicion for A. hemolyticum must be maintained in such cases, because it has proven to be a rare but aggressive, potentially occult, and life-threatening pathogen.

[Guillain-Barré syndrome with dysphagia after frontal sinusitis]. / Guillain-Barré-Syndrom mit Dysphagie nach Sinusitis frontalis.

One week after an acute sinusitis, a male patient developed a hypernasal voice, dysphagia, diplopic images, ataxia and paresthesias. He had paresis of the glossopharyngeal and abducens nerves, weakness of the arms and legs, and reflex deficiency. The neurography showed a motor axonal demyelinating neuropathy, so that the diagnosis of Guillain-Barré syndrome was made. After five courses of plasmapheresis, the symptoms improved rapidly.

[A case of subclinical frontal lobe abscess as a complication of sinusitis]. / Przypadek skapoobjawowego zatokowopochodnego ropnia plata czolowego mózgu.

Nowadays suppurative complications of sinusitis are uncommon in orderto widespread treatment with antibiotics. Intracranial complications include bacterial meningitis, encephalitis, brain abscess, epidural or subdural abscess and sinus thrombophlebitis.The 13-40% of all brain abscesses are sinogenic complications. The inflammation process spreads from sinuses by valveless diploic veins of the skull as thrombophlebitis or by direct extension of osteomyelitis. Jatrogenic, posttraumatic or natural fissures in bony walls can also take part in spreading the infection. Diagnostic process includes laryngological and neurological evaluation with the computer tomography scanning or magnetic resonance imaging. Patients with intracranial complications require broad-spectrum antibiotic therapy and surgical treatment in orderto remove the origin of infection in the sinuses. For physicians they are always challenging conditions according to their significantly high mortality. The case of the 24 year old patient with sinogenic brain abscess was shown in this paper. He neglected ambulatory treatment of chronic sinusitis because of lack of the medical insurance. After episode of losing the consciousness he was admitted to the ENT Department with headache, nausea, fever and dehydration. The diagnose was established based on laryngological and neurological examination and visualization of brain abscess on CT scans. He was treated by surgical intervention conducted by team of head and neck surgeons and neurosurgeons. Intensive antibiotic therapy with the Uffenorde operation of frontal sinuses and neurosurgical removal of the brain abscess was performed.The epidemiology, clinical course, diagnostic problems and therapy were described.

Spontaneous intracranial extradural haematoma associated with frontal sinusitis and orbital involvement.

Intracranial extradural hematoma is usually traumatic. Rarely, it can occur spontaneously associated with coagulative disorders (spontaneous or iatrogenic), dural vascular malformation, cranio-facial tumors and infections. In these cases, spontaneous extradural hematoma (SEH) is a serious event that needs to be recognized and managed in time to avoid fatal outcome. The authors report a case of a 12-year-old young girl with a 3-year history of right frontal sinusitis treated urgently for a right frontal extradural hematoma involving the orbit. Diagnosis and management of this case is discussed reviewing the pertinent literature.

[Pott's puffy tumor, a rare complication of frontal sinusitis]. / Tumeur de Pott, complication rare de la sinusite frontale.

Port's puffy tumour (PPT), corresponding to frontal osteomyelitis causing erosion of the anterior wall of the frontal sinus and subperiosteal abscess, is a rare but serious complication of frontal sinusitis or trauma to the region. It can occur even despite the use of antibiotics and requires surgical drainage of the abscess, excision of pathological tissues and obliteration of the frontal sinus by various materials. It can rarely progress to life-threatening intracranial extension. Practitioners must be extremely cautious in the presence of clinical signs suggestive of Pott's puffy tumour. The aim of this article is to present a case of progressively evolving PPT in a patient of 28 years by frontal headaches that are aggravated by painful swelling front soft and fluctuating by palpation and that has fistulated at the right upper eyelid. CT scan of the face revealed the presence of a discontinuity bone at the anterior wall of the right frontal sinus. The treatment consisted of surgery and antibiotics. The patient remained asymptomatic after a decline of 18 months.

[Acute and chronic frontitis: the current view of the problem].

The number of patients presenting with the inflammatory diseases of paranasal sinuses remains rather high both in this country and all over the world despite the development of new methods for diagnostics and treatment of this pathology and their extensive application in the clinical practice. The present paper offers a systematic review of the literature concerned with diagnostics of acute and chronic diseases of frontal sinuses published during the period from 2005 to 2011. The analysis of these publications has demonstrated that these diseases still constitute a challenging problem for otorhinolaryngology despite the improvement of technologies for their diagnostics and management. It is concluded that systematization of the available methods for this purpose is needed in conjunction with the standardization of the approaches to the choice of adequate surgical strategies.

Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis.

BACKGROUND: Dilation of sinus ostia using a high-pressure balloon has been introduced as a treatment for chronic rhinosinusitis (CRS) refractory to medical treatment. The efficacy of this technology, however, has not been systematically reviewed. OBJECTIVES: To assess the effectiveness of balloon sinus ostial dilation as a treatment for patients suffering with CRS refractory to medical treatment. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 20 December 2010. SELECTION CRITERIA: Randomised controlled trials in patients of any age with rhinosinusitis lasting longer than 12 weeks who have failed a prolonged course of medical treatment. Studies compared either balloon sinus ostial dilation or a hybrid procedure (balloon dilation in conjunction with functional endoscopic sinus surgery (FESS)) versus conventional surgery (e.g. FESS) or a waiting list control. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies for inclusion, extracted data and assessed risk of bias. MAIN RESULTS: One study (34 patients) met our inclusion criteria although it was not yet a peer reviewed publication. The study randomised patients with chronic frontal sinusitis who had failed a prolonged course of medical treatment into two groups: balloon dilatation of the frontal recess (plus conventional FESS of other involved sinuses) versus conventional FESS (Draf type 1/2a procedures on the frontal sinuses). At 12 months follow up there was no statistically significant difference in radiological resolution of frontal sinuses between the two groups. The percentages of directly observed patent frontal recesses at 12 months were 75% in the balloon dilation group versus 63% in the FESS-only group. The authors state that this was statistically significant but details of the analysis were not presented. Indeed the study as a whole suffers from a bias in the way its outcome measures were reported.No major complications were reported. Three patients in the FESS-only group required further revision frontal sinus surgery compared to one in the balloon dilation group, although synechiae were more common in the latter. AUTHORS' CONCLUSIONS: At present there is no convincing evidence supporting the use of endoscopic balloon sinus ostial dilation compared to conventional surgical modalities in the management of CRS refractory to medical treatment. With the escalating use of balloon sinuplasty, there is an urgent need for more randomised controlled trials to determine its efficacy over conventional surgical treatment modalities.

Balloon dilation of the frontal recess: a randomized clinical trial.

OBJECTIVES: We sought to evaluate the effectiveness and safety of balloon dilation of the frontal recess in the management of chronic rhinosinusitis of the frontal sinus. METHODS: We designed a double-blind randomized clinical trial of functional endoscopic sinus surgery assisted by balloon dilation versus conventional functional endoscopic sinus surgery in the treatment of chronic rhinosinusitis of the frontal sinus. We enrolled a total of 40 patients in whom medical therapy had failed. The patients were randomly allocated to balloon dilation or to conventional frontal sinus drainage with a Draf I procedure. The main outcome measures were resolution of frontal sinus disease confirmed by computed tomographic scan, and permeability of the frontal recess seen on endoscopy, both at 12 months. RESULTS: Of the 40 patients enrolled, 32 concluded the trial. In both groups, we obtained a statistically significant reduction in the Lund-Mackay stage. Resolution of frontal sinus disease confirmed by computed tomographic scan seemed to be more common after balloon dilation, although this finding was not statistically significant. Permeability of the frontal recess was seen on endoscopy statistically more frequently after balloon treatment (73% versus 62.5%). Only 4 patients needed revision surgery. No major complications were observed. CONCLUSIONS: Balloon dilation of the frontal recess is a relatively safe and effective tool in the management of chronic frontal rhinosinusitis after intensive medical treatment has failed.

Medical management versus surgical intervention of pediatric orbital cellulitis: the importance of subperiosteal abscess volume as a new criterion.

PURPOSE: To investigate age and frontal sinusitis as indications for the surgical management of pediatric orbital cellulitis with subperiosteal abscess (SPA) and to create an SPA volume criterion that would favor nonsurgical management. METHODS: A retrospective chart review was performed to find all patients age 18 years and younger who presented to Hasbro Children's Hospital with orbital cellulitis secondary to sinusitis with an SPA from 2005 to 2009. SPA volume was measured using a CT ruler at the largest axial, coronal, and sagittal dimensions. Student t testing was used for statistical analysis. RESULTS: Twenty-nine patients were included: 8 (27.6%) were managed surgically and 21 (72.4%) were managed medically. The mean age of patients undergoing surgical management was 7.0 years old versus medical management 6.1 years old and was statistically similar (p < 0.001). The age range of patients undergoing surgical management was 17 months to 11 years versus 4 months to 13.4 years for medical management. The mean volume of abscesses needing surgery were larger (3,446.3 mm) than abscesses not needing surgery (420.5 mm) (p < 0.04). Volumes of <1,250 mm did not require surgical management (p < 0.001). The frontal sinuses were visualized on CT scan in 17 patients; frontal sinusitis was found in 11 of 17 (64.7%) patients; of these 11 patients, 4 (36.4%) underwent surgical drainage and only 2 (18.2%) showed positive culture results. The 2 (18.2%) patients who had positive culture results had an SPA volume that was ≥ 1,250 mm. CONCLUSIONS: The volume of SPA seemed to be the most important criterion in determining medical versus surgical management. The volumes of abscesses needing surgery were larger than the volumes of abscesses not needing surgery. Volumes of <1,250 mm did not require surgical management. Most cases of SPA with concurrent frontal sinusitis do not require surgical intervention. The cases of frontal sinusitis requiring surgical intervention always had concurrent SPA volumes of ≥ 1,250 mm. Patients both under 9 years old and ≥ 9 years old required surgical intervention with SPA volumes of <1,250 mm being a consistent determining factor.

Initial clinical experience with balloon dilation in revision frontal sinus surgery.

OBJECTIVES: The purpose of this study was to determine whether balloon dilation is effective in revision frontal sinus surgery. METHODS: We retrospectively reviewed all patients who had previously undergone endoscopic frontal sinus surgery and had persistent sinusitis. All patients then underwent balloon dilation of the frontal ostium. Outcome measurements included endoscopic patency of the frontal ostium, Lund-Mackay scores, culture-positive postoperative infections, and subjective persistence of symptoms. RESULTS: Twenty-four frontal ostia and recesses were dilated in 13 patients. The mean follow-up was 13 months (range, 7 to 19 months). During follow-up, 21 of 24 ostia (86%) remained patent and 3 required additional procedures. Postoperative computed tomography scans were performed an average of 12 months after dilation (range, 6 to 18 months) in 9 patients (17 sinuses). The average Lund-Mackay score was 1.35 before dilation and 0.87 at follow-up (p = 0.0076), with 41% of sinuses (7 of 17) displaying radiographic improvement. The average number of postoperative infections was 2.07 (range, 0 to 7). Frontal headaches persisted in 38% of patients (5 of 13) at follow-up. CONCLUSIONS: Balloon dilation of the frontal ostia has a posttreatment patency rate comparable to those of other endoscopic revision techniques. Although it may not fully address the frontal sinus disease of all patients, it is a less invasive technique that may be helpful for some patients.

Frontal sinus obliteration by a composite multifractured osteoperiosteal flap: a pilot study.

The objective result is to obliterate the frontal sinus by a neo-osteogenic tissue, which develops behind the composite multifractured osteoperiosteal flap (CMOF) tailored from the anterior wall's bone cortex of the frontal sinus in the New Zealand rabbit model. In this study, as surgical objects 4 New Zealand rabbits were used. First, in each animal, the CMOF was formed from the anterior wall's bone cortex of the frontal sinus. After obtaining the CMOF, the remainder of the cortical bone of the anterior wall was removed by a drill. This procedure provided an anteriorly opened frontal sinus cavity, which has been filled firstly with absorbable gelatin sponge and finally covered with the CMOF. To investigate any possible neo-osteogenic activity behind the CMOF, CT scans of the paranasal sinuses were obtained on the first day and on the third month after surgery. Besides those, to histologically verify the developments, biopsies were obtained from behind the flap at the end of the third month. Evaluation of the CT images of the paranasal sinuses, confirms that more than half of the volume has been filled in frontal sinuses. Likewise, histologically, clear evidence of osteoblastic activity has been detected in each biopsy material. In this rabbit model, we have shown that more than half of the frontal sinus' cavity can be filled by the neo-osteogenic tissue forming behind the CMOF.

A Pott's puffy tumour as a late complication of a frontal sinus reconstruction: case report and literature review.

A Pott's Puffy Tumour (PPT) is a rare clinical entity, which, traditionally has been described as an acute abscess with periosteitis secondary to osteomyelitis of the external table of the frontal bone of the skull, complicating an acute frontal sinusitis. The aim of this article is to present a case of progressively evolving PPT, which emerged during the course of a common rhinitis, in a patient who, thirty years previously, had undergone a reconstruction of the frontal sinus involving osteosynthesis. The patient was treated with antibiotic therapy coupled with external access surgery using the Cairn Unterberger approach. This allowed the drainage of pus, the removal of infected osteosynthetic material and a complete debridement of osteomyelitic bone from the affected area. Frontal sinus obliteration was undertaken using methyl methacrylate, preferable in this case to hydroxyapatite, due to the direct communication with the neighbouring sinus cavities and the presence of defective bone in the superior orbit. A review of literature available on Medline up to January 2008 reveals that this is the third published case of PPT complicating a frontal reconstruction.

The Role of Free Tissue Transfer in the Management of Chronic Frontal Sinus Osteomyelitis.

OBJECTIVES/HYPOTHESIS: Chronic frontal sinus infection is managed with a combination of medical and surgical interventions. Frontal bone osteomyelitis due to recurrent infection following trauma or prior open surgery may require more significant debridement. Free tissue transfer may allow for extensive debridement with replacement of tissue, and definitive eradication of osteomyelitis. STUDY DESIGN: Retrospective chart review. METHODS: Patients undergoing free flap obliteration of the frontal sinus for frontal bone osteomyelitis at a single institution were included in the study. Clinical, radiologic, and surgical data were collected. Surgeries before and after free flap obliteration were compared by Wilcoxon signed rank test. RESULTS: Fifteen patients were identified; however, one patient had less than 6 months of follow-up and was excluded from analysis. Of the remaining 14 patients, mean follow-up duration was 26 months (range, 6-120 months). Mean number of surgeries prior to free flap was 3.7 (range, 1-8 surgeries). Free flap obliteration resolved chronic frontal sinusitis in all patients. Two patients experienced postoperative infection, and the overall complication rate was 29%. Eight patients underwent cranioplasty (six immediate, two delayed) without complication. All patients received planned courses of postoperative antibiotics. A statistically significant decrease in the number of surgeries after free flap obliteration was observed P ≤ .01). CONCLUSIONS: Extensive debridement followed by free tissue transfer and antibiotics offers a definitive treatment for complicated, recurrent frontal osteomyelitis. Simultaneous cranioplasty provides immediate protective and aesthetic benefit without complication. Consideration should be given for free tissue transfer and cranioplasty earlier in the algorithm for treatment of refractory frontal sinus osteomyelitis. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1497-1504, 2019.

[Causes and management of frontal sinusitis after transfrontal craniotomy].

Objective:The aim of this study is to investigate the causes and the strategy of frontal sinusitis after transfrontal craniotomy by endoscopic frontal sinus surgery and traditional surgery with facial incision. Method:A total of thirty-four patients with frontal sinusitis after transfrontal craniotomy were admitted, with the symptom of purulence stuff, headache and upper eyelid discharging. The onset time was 2.6 years on average. The frontal sinus CT and MRI images showed frontal sinusitis. Twenty-seven patients were treated with endoscopic frontal sinus surgery, and seven patient was treated with combined endoscopic and traditional frontal sinus surgery. In the revision surgery, the bone wax and inflammatory granulation tissue were cleaned out in both operational methods. The cure standard was that the postoperative frontal sinus inflammation disappeared and the drainage of the volume recess was unobstructed. Result:Thirty-four patients had a history of transfrontal craniotomy, and there was a record of bone wax packing in every operation. Among twenty-seven patients with endoscopic frontal sinus surgery, Twenty-five cases cured and two cases were operated twice. Seven patients were cured with combined endoscopic and traditional frontal sinus surgery. Conclusion:The frontal sinusitis after transfrontal craniotomy may be related to the inadequate sinus management, especially bone wax to be addressed to the frontal sinus ramming leading to frontal sinus mucosa secretion obstruction and poor drainage. Endoscopic frontal sinus surgery is a way of minimally invasive surgery. The satisfying curative effect can be obtained by endoscopic removal of bone wax, inflammatory granulation tissue, and the enlargement of frontal sinus aperture after exposure to the frontal sinus, and some cases was treated with both operation method.

Use of balloon catheter dilation and steroid-eluting stent in light and severe rhinosinusitis of frontal sinus: a multicenter retrospective randomized study.

OBJECTIVE: Frontal sinus surgery has an increased rate of re-stenosis, if compared to other sinuses. It depends mainly on recurrent inflammation and abnormal scarring at the frontal recess and its reduction represents one of the keys to therapeutic success. Balloon catheter dilation (BCD) and implantable sinus stents/spacers represent strategies to improve sinus ventilation respecting the integrity of mucosa and reducing abnormal post-surgical scarring. The purpose of this study was to evaluate the effectiveness, safety and correct indication about the use of BCD and a non-absorbable stent (Relieva Stratus™ MicroFlow spacer) in the management of chronic rhinosinusitis (CRS) of the frontal sinus. PATIENTS AND METHODS: In this multicentric retrospective study we included a population of 76 frontal sinuses with non-polypoid CRS. 41 frontal sinuses were treated with BCD alone and 35 frontal sinuses with BCD + Spacer. We analyzed both radiological (Lund-McKay CT scoring modified by Zinreich) and symptomatological results (SNOT-20 questionnaire) before surgery and after 12 months, dividing our population in two main groups: group "L" (light/mild frontal CRS) and group "S" (moderate/severe frontal CRS). RESULTS: Our results confirm a good safety and effectiveness of BCD in the management of frontal CRS and show a good safety but a not significative effectiveness of Relieva Stratus™ MicroFlow spacer when added to BCD in the management of light and severe frontal chronic rhinosinusitis. CONCLUSIONS: BCD is an acclared option in the management of frontal CRS and in the near future, utilization of stents/spacers could become a new and effective weapon in the management of rhinosinusitis, both like an adjunct to standard therapies, and in patient populations where the use of systemic drugs is contraindicated.