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 Puffy Tumor Caused by Dental Infection: A Case Report and Literature Review.

ABSTRACT: Pott puffy tumor (PPT), first described by Sir Percivall Pott in 1760, is a rare clinical entity characterized by a subperiosteal abscess associated with osteomyelitis of the frontal bone caused by direct or hematogenous spread. Although rare in this modern age of antibiotics, this tumor usually occurs as a complication of sinusitis. Moreover, intracranial complications such as subdural abscess, meningitis, sinus thrombosis, or brain abscess can occur concomitantly with the underlying sinusitis, despite the administration of antibiotics. Herein, we present the case of a 48-year-old man who was diagnosed with PPT using computed tomography and treated medically and surgically. The infection remained uncontrollable after surgery and drain removal, owing to the persistence of the original dental focus of the infection. This case highlights the importance of treating the source of the infection in addition to the local area of inflammation, to facilitate complete infection control in PPT.

Pott's puffy tumour of the frontal and Parietal bones with subgaleal abscess as a complication of acute sinusitis - a case report.

Acute sinusitis is a frequent medical condition that can affect any age group and may lead infrequently to very serious life-threatening complications. These complications include the spread of infection to frontal and other cranial bones, meninges, and other intracranial structures that require urgent medical actions to prevent mortality and morbidity. We report the case of acute frontal sinusitis in a 14 years old male who presented with fever, severe headache, and fluctuant swelling of the nasal root, and right supraorbital and frontoparietal regions. Imaging studies demonstrated signs of left-sided sinusitis, osteomyelitis of the frontal bones, and right parietal bone. Urgent surgery was performed with drainage of the abscesses and samples were sent for culture and sensitivity. Bilateral antral washout and trephination of the left frontal sinus was performed and pus was evacuated. Growth of Staphylococcus aureus and Peptostreptococcus micros was reported and according to the sensitivity report, the patient was kept on intravenous meropenem, 1500 mg per day and vancomycin 1500 mg per day was added on the 7th postoperative day. The patient was discharged from the hospital in good health on the 25th postoperative day and kept on oral vancomycin for one month.

A Case of Pott's Puffy Tumor Associated With Barosinusitis From Scuba Diving.

ABSTRACT: Barosinusitis, or sinus barotrauma, is a well-described condition associated with changes in barometric pressure during flight and diving that can result in sinonasal mucosal injury. In this case report, we present an adolescent who experienced barosinusitis during scuba diving and subsequently developed Pott's puffy tumor (PPT), characterized by frontal sinusitis, frontal bone osteomyelitis, and overlying subperiosteal abscess. This unique case of PPT following scuba diving provides the opportunity to review the pathophysiology of both barotrauma-induced sinus disease and PPT, a rare and unreported serious complication of barosinusitis. Furthermore, we discuss how scuba diving and associated barosinusitis can be considered a risk factor in the development of PPT.

Trauma-associated Pott's puffy tumor: an ophthalmologic perspective.

Pott's puffy tumor is a significant complication of frontal sinusitis that leads to frontal bone osteomyelitis and can be associated with frontal swelling, subperiosteal abscess, and intracranial abscess. It may be associated with antecedent trauma and typically presents in adolescents. Orbital involvement is rarely reported. We describe the case of a 15-year-old male who presented after blunt facial trauma with orbital hematoma and developed Pott's puffy tumor with orbital cellulitis and subperiosteal abscess. Management required a collaborative, multidisciplinary effort that yielded a good outcome.

Complications of Otitis Media and Sinusitis Caused by Streptococcus anginosus Group Organisms in Children.

BACKGROUND: The Streptococcus anginosus group (SAG, S. anginosus, S. intermedius and S. constellatus) are often associated with severe disease and abscess formation. In our institution, we observed an apparent increase in frequency of intraorbital and intracranial infections resulting from SAG at Texas Children's Hospital. We undertook a retrospective review to describe the frequency and clinical features of these infections. METHODS: We reviewed the database of the microbiology laboratory at Texas Children's Hospital from 2011 to 2018 for SAG-positive cultures. Cases included were those associated with (1) either otitis media or sinusitis and (2) Pott's puffy tumor, orbital abscesses, mastoiditis, epidural abscesses, subdural empyema, brain parenchymal abscesses or dural enhancement by imaging. The number of overall diagnoses were determined using diagnostic codes and used to estimate the proportion of disease caused by SAG. RESULTS: Ninety-five cases were identified meeting inclusion criteria. The median age of patients was 11.4 years, and 75.8% were previously healthy. S. intermedius was most commonly isolated (80%) followed by S. constellatus (12.6%) and S. anginosus (7.4%); 50.5% of cases were polymicrobial. Among polymicrobial cases, Staphylococcus aureus was most frequently isolated. All patients underwent surgical intervention. 8.4% of patients experienced persistent neurologic deficits. We observed a significant increase in disease incidence during the study period; in addition, the overall proportion of all intracranial infections caused by SAG increased. CONCLUSIONS: Complications of otitis media and sinusitis caused by SAG are associated with substantial morbidity. These infections are becoming increasingly common at our center although the precise reason for this temporal trend is unclear.

The Unknown Cause of Pott's Puffy Tumor ­ Importance of Early Diagnose

Pott's puffy tumor (PPT) is characterized by swelling of the glabelar region and osteomyelitis of the frontal bone, owing to a subperiosteal pseudoinflammatory tumor responsible for the detachment of the pericranium from the outer table of the skull. Nowadays, the incidence of PPT is very low, so this entity is frequently underdiagnosed. The late treatment and identification of PPT are strongly associated with intracranial complications, which could jeopardize the life of the patient. In the literature, PPT is described as a complication of frontal head trauma or of chronic sinusitis. There are a few cases reported in patients with frontal insect bites or in recreational nasal drug users, such as cocaine or methamphetamines. In the present case report, the authors describe the case of a 40-year-old male who was submitted to a frontal sebaceous cyst surgery. In the postoperative period, he developed an infectious process compatible with PPT. After an extensive review of the literature, no similar cases were identified. Therefore, in the opinion of the authors, sebaceous cyst surgery should be included in the short list of risk factors for the development of PPT.

Complicated Fusobacterium Sinusitis: A Case Report.

Fusobacterium infections and Lemierre syndrome are traditionally associated with pharyngitis. We report 3 cases of Fusobacterium sinusitis that resulted in Pott puffy tumor. One of these cases also had Lemierre Syndrome. We encourage expansion of the clinical spectrum of Lemierre syndrome to include complicated Fusobacterium sinusitis.

Minimally Invasive Surgery for Pott's Puffy Tumor: Is It Time for a Paradigm Shift in Managing a 250-Year-Old Problem?

INTRODUCTION: The aim of this study was to review the clinical outcomes and efficacy of endoscopic sinus surgery (ESS) in the management of Pott's puffy tumor (PPT). METHODS: Literature PubMed review using a combination of MeSH terms and keywords was undertaken, combined with a single surgeon case series of 3 patients. RESULTS: A total of 29 (20 males, median age 25 years) cases were reviewed. The most common etiology was acute frontal sinusitis (62%), followed by a history of chronic rhinosinusitis (28%). Two patients presented with concomitant preseptal cellulitis and cutaneous fistula each, while another had pneumocephalus. The majority of cases (59%) had Draf 1 procedure. Three cases had Draf 3 procedure. Five cases were successfully treated by sinus balloon sinuplasty. Postoperatively, most patients had either oral or intravenous antibiotics of varying duration. There were no further complications following ESS. Both fistulas healed without requiring surgical debridement or closure. CONCLUSION: Some PPT cases can be managed endoscopically. The availability of powered angled instruments, high-definition video, and image guidance systems have provided the modern otolaryngologists with a credible alternative to traditional techniques. Furthermore, improved bioavailability of modern antibiotics may obviate the need for craniotomy and external drains.

Propuesta de estadificación de las lesiones inflamatorias de la región frontal / Proposal for staging of inflammatory lesions in the frontal region

El aumento de volumen en la región frontal puede deberse a múltiples etiologías, dentro de las cuales deben considerarse: mucocele, tumor de Pott-Puffy, lesiones fibro-óseas, tumores de nariz y senos paranasales, lesiones intracraneales y metástasis. El objetivo del estudio fue describir el protocolo clínico empleado en los pacientes que se presentaron con aumento de volumen frontal y una propuesta de estadificación de las lesiones inflamatorias. Se realizó un estudio retrospectivo observacional. Se encontraron 7 casos con aumento de volumen en la región frontal: 4 casos secundarios a enfermedad inflamatoria (3 casos tumor de Pott-Puffy, un mucocele frontal) y 3 por neoplasia (un caso benigno y 2 malignos). Es muy importante considerar, entre los diagnósticos diferenciales de aumento de volumen en la región frontal, enfermedades inflamatorias que pueden representar una complicación grave de infecciones nasosinusales o neoplasias malignas avanzadas. Se propone un sistema de estadificación de las lesiones inflamatorias frontales (AU)

Frontal swelling can be due to multiple etiologies, including: mucocele, Pott's puffy tumor, fibro osseous lesions, benign and malignant neoplasms of the nose and paranasal sinuses, intracranial lesions, and metastasis. The objective of this study was to describe the clinical protocol used for the diagnosis of patients presented with frontal swelling and the proposal for staging of inflammatory lesions. We performed an observational retrospective analysis. We found 7 cases of patients with frontal swelling: 4 cases secondary to inflammatory pathology (3 Potts puffy tumors and one frontal mucocele), and 3 cases secondary to neoplasms (one benign and 2 malignant neoplasms). It's very important to consider the wide differential diagnosis that can present as frontal swelling, from inflammatory pathologies secondary to possible advanced infections of the paranasal sinuses to invasive malignant neoplasms. We propose a system of staging of frontal inflammatory lesions (AU)

Hospital cost of pediatric patients with complicated acute sinusitis.

OBJECTIVE: Review costs for pediatric patients with complicated acute sinusitis. METHODS: A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. RESULTS: The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. CONCLUSION: Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients.

Post-traumatic Pott's puffy tumour: A case report.

INTRODUCTION: Osteomyelitis of the frontal sinus is a rare clinical entity and generally occurs as a complication of trauma to the forehead or frontal sinusitis. It can be responsible for life-threatening complications, as the first symptoms may appear to be minor. Early diagnosis and appropriate management to prevent central nervous system complications significantly reduce the morbidity and mortality. CASE REPORT: The authors report the case of a 34-year-old man with Pott's puffy tumour following trauma to the frontal sinus. DISCUSSION: The diagnosis was suggested clinically and confirmed radiologically. Treatment was surgical with craniotomy and external drainage.