Pott's Puffy Tumor in Pediatric Patients: Case Series and Literature Review.

BACKGROUND: Pott's puffy tumor (PPT) is a rare complication of frontal sinusitis. Although it may occur at any age, the incidence is higher during adolescence. METHODS: We report a series of 10 pediatric patients (9-17 years of age) who presented with PPT in 2 tertiary care pediatric hospitals in central Israel between January 2018 and August 2022 and review the published literature on pediatric PPT. RESULTS: The most common clinical presentations included headache (10 cases), frontal swelling (6 cases) and fever (5 cases). Symptom duration before admission was between 1 and 28 days (median 10 days). The diagnosis of PPT was made by imaging studies at a median of 1 day after admission. All 10 patients underwent computed tomography studies, and 6 patients also underwent magnetic resonance imaging. The overall rate of intracranial complications was 70%. All 10 children were treated with systemic antibiotics and surgical interventions. Streptococcus constellatus group was the most common causal bacteria. All 10 patients recovered uneventfully. CONCLUSIONS: Our findings show that a high index of suspicion for PPT should be applied to adolescents presenting with prolonged headache and frontal swelling. Contrast-enhanced computed tomography is an appropriate first tool for the evaluation; however, an magnetic resonance imaging should be performed to determine the necessity of intracranial interventional treatments if there is any suspicion of intracranial involvement. Complete recovery can be expected with appropriate antibiotic treatment and surgical intervention in most of the cases.

Tumor de Pott y absceso cerebral secundario a sinusitis aguda de foco dentario en paciente pediátrico / Pott's tumor and cerebral abscess secondary to acute sinusitis of dental focus in a pediatric patient

El tumor de Pott es una entidad rara, definida como un absceso subperióstico asociado a osteomielitis del hueso frontal. Suele presentarse como complicación de sinusitis aguda o crónica del seno frontal, y se describe con mayor incidencia en población pediátrica, siendo una complicación grave por su alta morbimortalidad. Se presenta a un paciente pediátrico con tumor de Pott y absceso cerebral posterior a una sinusitis aguda de foco odontogénico, en la que los pilares de tratamiento son drenaje quirúrgico precoz y antibioticoterapia prolongada. Se describe la clínica, manejo médico-quirúrgico y seguimiento posterior, ya que, en ausencia de antecedentes, se debe buscar dirigida- mente enfermedad periodontal y realizar un estudio de inmunodeficiencia primaria.

Pott's tumor is a rare entity, defined as a subperiosteal abscess associated with osteomyelitis of the frontal bone. It usually presents as a complication of acute or chronic sinusitis of the frontal sinus and it is described with a higher incidence in the pediatric population, being a serious complication due to its high morbidity and mortality. We present a pediatric patient with Pott's tumor and brain abscess after acute sinusitis of odontogenic focus, in which the pillars of treatment are an early surgical drainage and prolonged antibiotic therapy. The clinic, medical-surgical management and subsequent follow-up are described, since in the absence of antecedents, periodontal disease should be sought directly and a study of primary immunodeficiency performed.

Frontal Bone Osteomyelitis in Adult.

Frontal bone osteomyelitis is a rare clinical disease which occurs as a result of frontal sinusitis, penetrating injury on head, post-operative complication after sinus surgery and hematogenous spread from distant site. Early diagnosis, appropriate surgical debridement and antibiotic are keys to prevent from life threatening intracranial complications. We report a 63 years old male patient with osteomyelitis of outer cortex of frontal bone. The wound was thoroughly debrided after computer tomography scan showed an osteolytic lesion on outer table of fontal bone and antibiotic was continued for 2 months until inflammatory markers become normal. Keywords: Frontal bone; Intracranial complications; osteomyelitis; pott's puffy tumour.

Pott's Puffy Tumour: a rare but sinister cause of facial swelling.

A 27 year old female presented to the emergency department with intermittent central forehead swelling over several months associated with a headache. She was admitted under the medical team as having had a suspected allergic reaction but the diagnosis of a Pott's Puffy Tumour was quickly made and confirmed through CT and MR imaging. This uncommon condition is related to sinusitis leading to localised abscess formation with osteomyelitis and a subsequent swollen appearance over the affected facial sinus. This patient's sinus abscess extended into the epidural space and caused destruction of the anterior and posterior walls of the frontal sinus. The patient was managed with intravenous antibiotics, analgesia and referral to the local ENT team for surgical intervention.

Empiema subdural recidivante secundário à sinusite bacteriana frontal em um adolescente imunocompetente: relato de caso / Relapsing subdural empyema secondary to frontal bacterial sinusitis in an immunocompetent adolescent: case report

A sinusite é uma causa rara de infecção intracraniana, sendo responsável por 2,4% dos casos em pacientes jovens, e tem como a complicação intracraniana mais frequente o empiema subdural (ESD). Descrevemos um caso raro de um adolescente imunocompetente de 16 anos que evoluiu com confusão mental, rebaixamento do nível de consciência, anisocoria, hemiparesia à direita, afasia e febre. Tomografa computadorizada confirmou ESD, e paciente foi submetido à avaliação laboratorial e abordagem clínico-cirúrgica para tratamento do quadro.

Sinusitis is a rare cause of intracranial infection, accounting for 2.4% of cases in young patients. The most frequent intracranial complication is subdural empyema (SDE). We describe a rare case of a 16-year-old immunocompetent adolescent who developed mental confusion, lowered consciousness, anisocoria, right hemiparesis, aphasia, and fever. Computed tomography confirmed SDE, and the patient underwent laboratory evaluation and clinical-surgical approach for treatment of the condition.

Minimally invasive treatment of sino-nasal aspergillosis in dogs.

BACKGROUND: Sino-nasal aspergillosis is a common nasal disease in dogs. Recommended treatment protocols typically involve trephination of the frontal sinuses or the use of an antifungal solution instilled into the frontal sinus under anesthesia, both of which have associated morbidity and complications. OBJECTIVES: To assess a minimally-invasive topical treatment protocol for sino-nasal aspergillosis in dogs. ANIMALS: Twelve client-owned dogs diagnosed with sino-nasal aspergillosis that completed recommended treatment. METHODS: Medical records were retrospectively reviewed to identify dogs with sino-nasal aspergillosis that received treatment. Fungal plaques were manually debrided and irrigated via frontal sinuscopy in 12 dogs that then were treated topically with 1% topical clotrimazole cream. Irrigation and topical medication application was achieved using a catheter placed retrograde directly into the frontal sinuses using the Seldinger technique over a guidewire, thereby avoiding the need for frontal sinus trephination. Invasion into the calvarium was recorded before treatment but was not considered a criterion for exclusion. Debridement and cream deposition was repeated every 2 weeks as needed until negative culture and histopathologic findings were obtained. RESULTS: All dogs were cured (negative results for Aspergillus on endoscopy, fungal culture, and histopathology) with a median of 2 treatments. Treatments were well tolerated, with minimal adverse effects reported. Three dogs had evidence of erosion into the calvarium on computed tomography imaging. CONCLUSIONS AND CLINICAL IMPORTANCE: This protocol appears to be an effective and well-tolerated minimally invasive treatment for sino-nasal aspergillosis, including in dogs with erosion into the calvarium. Only mild adverse effects were noted.

Sepsis + ptosis = an unusual diagnosis.

The authors present the case of a 19-year old man presenting to the emergency department with a 2-day history of left eye pain and ptosis, facial pain around the maxillae, coryza, headaches and fevers. He had a background of autism, mild learning disability, obsessive-compulsive disorder and asthma. Within the last month, his risperidone and sertraline doses had been increased. Basic observations and investigations suggested sepsis: tachypnoea, sinus tachycardia, fever and a raised white cell count and C reactive protein level. A CT head showed sinonasal polyposis and moderate chronic rhinosinusitis, with normal intracranial appearances. An MRI head showed evidence of extension of frontal sinus infection through the posterior wall of the left frontal sinus with subsequent left frontal extradural empyema. Intravenous antibiotics and surgical drainage of the left frontal sinus resulted in clinical improvement and discharge to complete the course of antibiotics in the community.

Medical Management of Frontal Sinusitis.

Rhinosinusitis is a term that has long been used to describe a diverse disease entity that encompasses several related but distinct conditions involving the paranasal sinuses. Frontal sinusitis represents one such entity with its own unique treatment considerations. Like rhinosinusitis as a whole, the role of medical management in the treatment of frontal sinusitis cannot be overlooked. Contemporary medical management of frontal sinusitis requires recognition of the unique disease process with implementation of targeted therapies aimed at addressing the specific pathophysiology.

Overview of Frontal Sinus Pathology and Management.

The frontal sinus is the most complex of all paranasal sinuses. Given its proximity to the cranial vault and orbit, frontal sinus pathology can progress to involve these structures and lead to significant morbidity, or even mortality. Surgical management of the frontal sinus is technically challenging. Various open and endoscopic surgical techniques are available to the otolaryngologist. This article presents an overview of the major disease entities that affect the frontal sinus, with a special emphasis on treatment principles and surgical management.

Outcomes of chronic frontal sinusitis treated with ethmoidectomy: a prospective study.

BACKGROUND: In medically refractory chronic frontal sinusitis, ethmoidectomy without instrumentation of the frontal ostium may resolve frontal disease. Our aim was to determine the efficacy of ethmoidectomy alone for the treatment of chronic frontal sinusitis. METHODS: Adults with chronic rhinosinusitis prospectively enrolled in a multicenter study who demonstrated frontal sinusitis on computed tomography were divided into 2 groups: (1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy, but excluding frontal sinusotomy; and (2) ESS incorporating frontal sinusotomy. The primary outcome was improvement in 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Secondary outcomes included endoscopic scores and use of corticosteroids and antibiotics. RESULTS: A total of 196 cases undergoing frontal sinusotomy and 30 cases treated with ethmoidectomy without frontal sinusotomy were analyzed and were comparable demographically. The prevalence of nasal polyps, previous ESS, asthma, and aspirin intolerance was more common in the frontal sinusotomy group (p < 0.050). Preoperative endoscopy and computed tomography scores were higher in the frontal sinusotomy group (p ≤ 0.001). Postoperatively, both groups showed comparable SNOT-22 scores with worse endoscopy scores in the frontal sinusotomy group (p = 0.038). Postoperative improvement in SNOT-22 total and subdomain scores was comparable between groups. Nasal endoscopy scores improved to a greater degree in the frontal sinusotomy group (p = 0.023). Duration of postoperative topical steroid use was higher in the frontal sinusotomy group (p = 0.007). Revision surgery was needed in 2.6% of frontal sinusotomy patients and 0% of patients without frontal sinusotomy. CONCLUSION: The treatment of chronic frontal sinusitis through ethmoidectomy is a potential alternative to frontal sinusotomy achieving similar quality of life (QOL) improvements in patients manifesting less severe sinus disease.

Approach on rehabilitation of patients after functional endonasal surgery of the frontal sinus.

INTRODUCTION: Endonasal surgery of the frontal sinuses is associated with impaired mucosal integrity, the aerodynamics of the nasal cavity, the configuration of intranasal structures. At the stage of early postoperative period, it is important to achieve rapid epithelialization of the mucous membrane, with the restoration of the functioning of the mucociliary transport system, drainage and ventilation of the sinuses, nasal congestion and as a result, early clinical recovery of the patient. AIM: to prove the clinical efficacy of formulations containing sodium hyaluronate in the postoperative period in patients undergoing endoscopic endonasal surgery of the frontal sinus. MATERIALS AND METHODS: the study was conducted on 36 patients, including 23 of a test, and 13 - a control group. All patients underwent endonasal surgery of the frontal sinus. Postoperatively, the patients of the main group, in addition to standard therapy, received products based on sodium hyaluronate, control - standard therapy. The study used a medical gel based on sodium hyaluronate Deviskar®.The results of the study were based on rhinoscopic diagnostic, rhinomanometry, subjective methods of patient questionnaires. CONCLUSIONS: the use of study preparation in complex treatment of patients with chronic sinusitis allows to achieve the best results the restoration of the mucous membrane of the nasal cavity and nasal breathing function, which has been proved for objective and subjective criteria. The study results allow us to recommend the use of sodium hyaluronate intraoperative and postoperative patients who underwent rhinosurgery intervention as an effective anti-inflammatory agent and mucous reducing agent.

[Pott's puffy tumour is a rare complication of sinusitis].

Pott's puffy tumour is a well known but rare complication of frontal sinusitis or trauma. It was first described by Sir Percivall Pott in 1768. Pott's puffy tumour is characterized by subperio-steal abscess associated with osteomyelitis. This report presents a 43-year-old patient with schizophrenia who developed Pott's puffy tumour due to lack of sufficient treatment of sinusitis. Furthermore, the literature on the clinical manifestations, diagnosis, microbiology, treatment, and complications of Pott's puffy tumour is reviewed.

Pott puffy tumor in a 5-year-old girl with frontal sinusitis.

We describe the case of a 5-year-old girl with a Pott puffy tumor on her forehead. Computed tomography confirmed frontal sinusitis and an epidural abscess. This case is unusual in that the patient's age at presentation was younger than the age when the frontal sinuses are believed to develop.

Trephination of the frontal sinuses and instillation of clotrimazole cream: a computed tomographic study in canine cadavers.

OBJECTIVE: To use computed tomography (CT) to assess the distribution of surgically administered clotrimazole cream and associated filling of the frontal sinuses and caudal aspect of the nasal cavities in canine cadavers. STUDY DESIGN: Observational study. ANIMALS: Small (n = 1) and medium-large (n = 11) breed canine cadavers. METHODS: CT scans of 12 cadaveric canine heads were used to confirm absence of sinonasal disease. Then after creating an opening into the left and right frontal sinuses with a 3.2 mm Steinmann pin at standardized landmarks, clotrimazole cream (20 g) was instilled into each side. Postoperative CT scans of the heads was used to assess the distribution and degree of filling of the sinonasal cavities with clotrimazole cream, and to identify any damage to local structures. RESULTS: Filling was excellent in 22 sinuses, very poor in 2, and excellent in all caudal nasal cavities. Two cadavers had damage: unilateral penetration of the cranium (2) and unilateral penetration of the lateral sinus wall (1). CONCLUSION: Excellent filling of most of the frontal sinuses and caudal nasal cavity of cadavers with clotrimazole cream is achieved when administered by this technique. Damage to local structures may occur intraoperatively using this technique.

Pott's puffy tumour and intracranial complications of frontal sinusitis in pregnancy.

INTRODUCTION: A Pott's puffy tumour is a subperiosteal abscess and osteomyelitis of the frontal bone secondary to frontal sinusitis. Intracranial complications are seen in approximately 40 per cent of cases and are potentially life-threatening; such complications have not previously been reported in pregnancy. CASE REPORT: A 21-year-old woman at 35 weeks' gestation presented with a history of frontal headaches and swelling, periorbital oedema, pain and chemosis. Imaging confirmed Pott's puffy tumour with right-sided epidural empyema and periorbital cellulitis. A multidisciplinary team was involved in the patient's management. Intravenous antibiotics were commenced and initial percutaneous drainage through the frontal sinus skin was performed, followed by endoscopic sinus drainage. A caesarean section was performed 3 days later. Complete resolution of the sinus and intracranial collections was noted on imaging performed six weeks later. CONCLUSION: This case highlights the challenges of managing rare intracranial complications of sinusitis in pregnancy, and the importance of multidisciplinary care.

Pott puffy tumor: a rare complication of sinusitis.

Pott puffy tumor, a rare complication of sinusitis in adults, appears as a localized swelling over the frontal region or forehead. This swelling is due to a subperiosteal abscess resulting from osteomyelitis of the underlying frontal bone. This condition may be associated with an epidural purulent collection, subdural empyema, and intracerebral abscess. This entity is rare--even forgotten--since the advent of modern powerful antibiotics. A 27-year-old male was referred to ENT OPD with forehead swelling, fever and headache. The patient had mooth doughy swelling of the foreheadwith surrounding cellulitis and swelling spreading to the orbits as periorbital odema. On examination, patient had very poor oral hygiene with severe dental caries. CT with contrast conformed pansinusitis with erosion of frontal bone and abscess. An early recognition of this forgotten complication of sinusitis will help avoid severe neurological sequelae and increased morbidity and mortality.

[A new method for the treatment of acute frontitis in the adult patients].

The objective of the study is to estimate the efficacy of Bioparox (fusafungine) when used for the treatment of the adult patients presenting with acute frontitis. Twenty two of the 45 patients with this condition were given adjuvant therapy using this preparation. It resulted in a decrease of the concentration of Staphylococcus aureus and S. epidermidis to 10 CFU/ml and 500 CFU/ml respectively. S. haemoliticus was completely eradicated. The concentrations of these microorganisms in patients of the control group were higher. The level of interleukin 1-beta in the secretion within 5 days after the onset of therapy was twice lower than in the patients of control group. The concentration of IL 1-beta in the serum of the treated with Bioparox patients was 4 pg/ml compared with 8 pg/ml in the control group. The efficacy of therapy of acute frontitis with fusafungine was confirmed in the X-ray study. It is concluded that the use of Bioparox for the management of acute frontitis increases the efficacy of the treatment and result in the marked improvement of the patients' condition within 5 days after the onset of therapy.

Maxillary odontogenic sinusitis, complicated with cerebral abscess--case report.

Maxillary sinus inflammation, when untreated or incorrectly treated, may extend locoregionally, the remaining paranasal sinuses being the first affected anatomical structures. This is why the understanding of the inflammatory pathology of the maxillary sinus, and particularly of the complications it can generate, is extremely important. The purpose of this presentation is to point out that inflammations of the paranasal sinuses are susceptible to develop complications in certain conditions and threaten the patient's life due to the proximity of vital structures. This is the case of a 16 years old male patient who developed a left maxillary and frontal sinusitis, complicated with cerebral abscess. Early detection, multidisciplinary approach and proper indication of surgical treatment, as well as early suspicion of complication, especially in young male adolescents, are extremely important.