A 9-year-old boy with a nonmalignant forehead tumor - a rare case of pediatric Pott's puffy tumor.

BACKGROUND: Pott's puffy tumor (PPT) is a rare and potentially deadly complication of frontal sinusitis consisting of subperiosteal abscess and osteomyelitis of the frontal bone. CASE PRESENTATION: We report the case of a 9-year-old boy who presented with fever and soft tissue swelling of the forehead. Magnetic resonance imaging (MRI) depicted an abscess in the subcutaneous tissue frontally and an epidural empyema, while a cranial computed tomography (CT) scan revealed bone erosion as a sign of osteomyelitis. The patient was treated accordingly. CONCLUSIONS: This rare condition is essential to keep in mind as it needs a multidisciplinary approach and relevant imaging to start proper treatment and thus decrease the risk of intracranial complications.

Pott's puffy tumor: A comprehensive review of the literature.

PURPOSE: Pott's puffy tumor (PPT) is a rare clinical entity characterized by osteomyelitis of the frontal bone with subperiosteal abscess collection. The frequency of reported cases of PPT in the literature has increased in recent years. Previous reviews of PPT exist primarily in the form of small, retrospective case series and anecdotal case reports. Therefore, the aim of this study is to provide the literature's largest comprehensive, up-to-date review of the essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches utilized in the management of PPT, both in pediatric and adult populations. MATERIALS AND METHODS: We searched MEDLINE, PubMed, and Embase databases for English-language studies published from January 1950 through January 30, 2022. The authors reviewed all cases of PPT, focusing specifically on those describing therapeutic management of PPT. A total of 321 patients were included, consisting of 318 patients (from 216 articles) and an additional 3 adult cases from our institution. RESULTS: PPT most often results from untreated rhinosinusitis, as well as direct head trauma, substance use, and odontogenic disease. Infections are classically polymicrobial with an anaerobe-predominant microbiome. Both CT and MRI imaging modalities are commonly obtained for presurgical assessment of sinusitis and intracranial extension. The core of treatment is an early and aggressive approach to prevent long-term complications. A significant association exists between surgical management and clinical outcomes for patients with PPT. Recent literature suggests endoscopic sinus surgery is essential for successful disease resolution. CONCLUSIONS: PPT is an important and relatively morbid disease process that is often underrecognized and misdiagnosed at presentation due to its variable clinical presentation. Management of PPT includes both antimicrobial therapy and surgical intervention. Determination of the optimal approach depends on patient clinical features including age, history of prior endoscopic sinus surgery, and presence of intracranial involvement on presentation. An individualized, targeted, and interdisciplinary approach to the treatment of PPT is critical for successful disease resolution.

Pott's Puffy Tumor and Intranasal Cocaine Abuse.

Pott's puffy tumor (PPT) is a rare subperiosteal abscess of the frontal bone with osteomyelitis, which most commonly affects adolescents as a complication of frontal sinusitis or head trauma. The Authors describe a case of development of a PPT in a woman who abused of cocaine for at least five years and presented with a gradually enlarging mass of the forehead. The patient was treated surgically through combined endoscopic and open approach and medically with antibiotic therapy. The PPT, as rare complication of intranasal cocaine abuse, was described until now in four patients. Even rare it can be a fearsome complication, making of fundamental importance an early diagnosis and a correct management.

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.

Unusual Cause of Seizure: Pott Puffy Tumor.

Seizures is a comparatively common neurologic unwellness in children that has significant implications for development, parents, and society. The etiologic categories of seizures involve idiopathic, symptomatic, and cryptogenic. Pott puff tumor is a rare cause of seizures. The authors present a rare cause of the seizures.A 12-year-old boy presented with seizures. On physical examination there was swelling on his glabella. Laboratory testing indicated leukocytosis and increased C-reactive protein, and microbiological testing showed the presence of pathogenic streptococcus sp. Brain magnetic resonance imaging was performed. T1-weighted image with gadolinium enhancement revealed frontal bone defects and subcutaneous abscess and left frontal swelling. On the diffusion-weighted imaging, the abscess has relatively homogeneous increased signal intensity b1000. The apparent diffusion coefficient map reveals low intensity. Intracranial spread also showed contrast-enhanced image (). Magnetic resonance imaging typically reveals an intracranial abscess.Pott puffy tumor is an unusual clinical existence characterized by osteomyelitis of the frontal bone. The very common symptoms are headache, swelling fever, and nasal discharge. Frontal sinus infection may induce osteomyelitis, subperiosteal, and epidural abscess.

Neurosurgical implications of Pott's puffy tumor in children and adolescents.

INTRODUCTION: Pott's puffy tumor (PPT) is rare and usually seen as a complication of frontal sinusitis resulting in subperiosteal abscess of the frontal bone with underlying osteomyelitis. PPT is potentially severe and can lead to life-threatening intracranial complications. PATIENTS AND METHODS: The authors present a series of six pediatric patients diagnosed with PPT and intracranial complications between 1999 and 2012. There were five boys and one girl, and the mean age at diagnosis was 11.8 years. All patients presented with frontal swelling, headache, and fever. Two patients had lowered level of consciousness and severe hemodynamic instability. RESULTS: All patients had epidural abscess, and one also presented subdural empyema. Five patients underwent drainage of all associated abscesses, bone resection, and sinusitis treatment. One was treated conservatively with broad-spectrum antibiotics, and no surgical intervention was required. All patients fully recovered their neurologic status, without further complications.

Pott's puffy tumor: A rare complication of sinusitis. A case report. / El tumor inflamatorio de Pott: una complicación infrecuente de la sinusitis. Reporte de caso.

A rare complication of frontal sinusitis includes Pott's puffy tumor. It manifests as a swelling of the forehead due to the presence of a subperiosteal abscess secondary to osteomyelitis of the frontal bone. A timely diagnosis allows for an early, intensive medical and surgical treatment, which is critical to prevent serious intracranial complications. Here we describe the case of a 12-year-old boy with Pott's puffy tumor as a complication of pansinusitis. This case was a diagnostic challenge; however, a timely treatment allowed for a favorable clinical course.

Una complicación infrecuente de la sinusitis frontal es el tumor inflamatorio de Pott. Se manifiesta como una tumefacción en la frente por la presencia de un absceso subperióstico secundario a una osteomielitis del hueso frontal. El diagnóstico oportuno permite un tratamiento intensivo médico y quirúrgico precoz, esencial para evitar complicaciones intracraneales graves. Se presenta el caso de un varón de 12 años con un tumor inflamatorio de Pott como complicación de una pansinusitis. Representó un desafío diagnóstico; sin embargo, la instauración del tratamiento oportuno permitió una evolución clínica favorable.

[Characteristics and therapeutic strategies of Pott's puffy tumor].

Objective:To explore the characteristics and therapeutic strategies of Pott's puffy tumor（PPT）. Methods:The clinical data of two patients with PPT were retrospectively analyzed and combined with the literature, focusing on the comprehensive analysis of perioperative diagnosis and treatment strategies. Both patients underwent muti-disciplinary treatment, including timely administration of sufficient antibiotics capable of penetrating the blood-brain barrier. Early removal of PPT lesions was performed using a combined internal and external approach under nasal endoscopic guidance. Results:After standardized perioperative management, the symptoms of the two patients were completely relieved, with no recurrence after one=year follow=up. Postoperative complications such as frontal pain, numbness, local depression, or scar hyperplasiawere not present. Conclusion:PPT, being relatively rare and severe, requires careful attention. Key strategies for standardized perioperative management include multi-disciplinary consultation, timely and adequate antibiotic administration, and surgical intervention using a combined intranasal and extranasal endoscopic approach for lesion removal.

Pott luck.

A 10-year-old boy presented with headache, fever, left-sided ptosis, and right-sided forehead soft tissue swelling. There was no recent history of trauma or infection. The patient had a large, fluctuant mass on the right side of his forehead, upgaze restriction, left-sided ptosis, and bilateral optic disk edema. Magnetic resonance imaging of the brain showed a frontal bone extradural fluid collection superficial to the superior sagittal sinus in keeping with an epidural abscess. There were multiple venous thromboses and thickening and enhancement of the dura, compatible with meningitis. There was right sphenoid sinusitis. This patient had Potts puffy tumor, a rare diagnosis associated with a forehead swelling from frontal bone osteomyelitis and subperiosteal abscess. It is seen in the pediatric population in association with sinusitis or trauma. Antibiotics, anticoagulation, and acetazolamide were initiated, and the epidural abscess was evacuated. The symptoms and signs resolved with treatment.

Pott's Puffy Tumor: A Rare, Life-Threatening Presentation of Periorbital Edema.

Pott's puffy tumor (PPT) describes forehead swelling with associated frontal bone osteomyelitis and a subperiosteal abscess (SPA) requiring a high suspicion index for optimal outcomes. PPT is a life-threatening complication of frontal sinusitis typically found in adolescents. Our case is one of the youngest in the literature. This report describes a 3-year-old patient who developed multifocal abscesses in the epidural space with frontal and orbital SPA, requiring surgical intervention. Additionally, her course was complicated by a superior sagittal venous thrombosis, a complication commonly associated with PPT. We present an unusual case of orbital SPA and aim to highlight a life-threatening pediatric condition that is often underrecognized.

Unusual Presentation of Pott's puffy tumour in a child: our recent experience and review of the literature.

Pott's puffy tumour (PPT) is a rarely seen, but highly important, complication of frontal sinusitis. Early recognition followed by prompt imaging and treatment of this condition are essential to improve patient outcomes and prevent complications. This case report describes an atypical presentation of radiologically confirmed PPT in a boy who presented with a 2.5-week history of progressive frontal headache and midline frontal swelling. Flexible nasendoscopy revealed no acute findings. Prompt CT imaging confirmed the diagnosis and early surgical intervention via endoscopic approach with aggressive antibiotic therapy led to good recovery. This case highlights the need to remember PPT in assessing any child or adolescent with a new forehead swelling, with or without sinusitis symptoms. If there is strong clinical suspicion, further imaging should not be delayed. Surgical intervention should be performed as early as possible to prevent intracranial complications; antibiotics alone are not sufficient.

Odontogenic Sinusitis-Associated Pott's Puffy Tumor: A Case Report and Literature Review.

Pott's puffy tumor (PPT) is a nonneoplastic complication of acute frontal sinusitis characterized by subperiosteal abscess (SPOA) formation and osteomyelitis. Although various clinical conditions are associated with frontal SPOA, cases associated with odontogenic sinusitis are rare. We report a recurrent case of frontal SPOA who had a previous history of craniotomy due to head trauma. The patient was presented with headache, facial swelling and diagnosed as frontal, ethmoid, and maxillary sinusitis with frontal SPOA, which is PPT. The patient was surgically managed by endoscopic sinus surgery and external drainage of the abscess. Although the symptoms had been relieved soon after the surgery, they were recurred after 1 week. By paranasal sinus computed tomography scans, it was suspected that severe carious teeth, which were missed before surgery, induced maxillary sinusitis which spread into the frontal sinus and subperiosteal areas inducing recurrence of disease. Our experience suggests that frontal SPOA may originate from odontogenic maxillary sinusitis caused by severe dental caries, which should be actively managed, especially in patients with the risk of spread of inflammation, such as those who have discontinuity in frontal bone.

Pott's puffy tumor in a 23-month-old: Youngest known case of a rare disease.

This case report describes a child who developed Pott's puffy tumor and was treated at the Children's Mercy Hospital in Kansas City. In addition to a discussion of a case, a review of the literature was completed on this topic describing the typical embryology and development of the frontal sinus, and the epidemiology, diagnosis, and treatment of Pott's puffy tumor. The patient was a 23-month-old boy who developed Pott's puffy tumor after recovery from influenza. The patient presented to the hospital with progressing edema of the unilateral eye that spread bilaterally within a few days. A CT scan demonstrated pansinusitis, developed frontal sinuses, right periorbital cellulitis, and medial forehead subperiosteal abscess. Functional endoscopic sinus surgery and transcutaneous abscess drainage were urgently performed and the patient made a full recovery following a course of ertapenem and levofloxacin. The presence of a developed frontal sinus in a 23-month-old is an unexpected radiologic finding. This case represents the youngest patient reported in the literature to develop this rare complication of frontal sinusitis.

The Pott's puffy tumor: a dangerous sign for intracranial complications.

The Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with osteomyelitis. The purpose of this article is to alert the physician to the severe complications of this entity. The records of six patients were reviewed retrospectively. There were four adults and two adolescents. Nasal endoscopy showed edematous, polypoid mucosa in middle meatus in three and nasal polyps in the rest. At initial admission, two had orbital subperiosteal abscess, but normal cranial CT findings. During hospitalization, three experienced frontal lobe abscess and one frontal cerebritis. Endoscopic sinus surgery was performed in all with external drainage of Pott's puffy tumor in addition to antibiotherapy. Three patients underwent craniotomy/craniectomy for removal of frontal lobe abscesses. One patient with frontal lobe abscess died. Pott's puffy tumor may result in potentially dangerous intracranial complications. Early diagnosis and treatment are essential to reduce morbidity and mortality.

Pott's Puffy Tumor.

Pott's puffy tumor is a potential complication of acute frontal sinusitis, characterized by subperiosteal abscess and osteomyelitis of the frontal bone. It can be managed with a combination of open and endoscopic sinus surgery and intravenous antibiotic therapy. In the current report, a 15-year-old male presented with a classic case of Pott's puffy tumor which was managed with bilateral ethmoidectomies, frontal sinusotomies, and frontal sinus trephination, resulting in discharge on intravenous antibiotic therapy and subsequent complete resolution of symptoms.