The Pott puffy tumor revisited: neurosurgical implications of this unforgotten entity

Abstract

The Pott puffy tumor is a subperiosteal abscess of the frontal bone that appears as a localized swelling of the overlying region of the forehead associated with frontal osteomyelitis. The authors report the case of an 11-year-old boy who presented with a 6-week history of frontal headaches and a recent sudden-onset, progressively enlarging swelling of his midline forehead associated with immediate relief of headaches. A computed tomography (CT) study revealed 1) a subperiosteal abscess with intracranial extension through the perforated posterior table of the frontal sinus and 2) a large epidural abscess overlying a compressed and narrowed superior sagittal sinus. Emergency surgical relief of the epidural abscess, curettage of the osteomyelitic bone, and excision of the periosteal granulomatous puffy lump were performed. A 6-week course of intravenous antibiotic medication was completed, and the patient had an excellent recovery. The Pott puffy tumor remains a serious complication of frontal sinusitis. In the past 5 years, the frequency of published pediatric cases has increased. Undiagnosed or partially treated frontal sinusitis may lead to this serious complication, and the apparent increase in incidence rate may suggest that this complication of frontal sinusitis could be underestimated in clinical practice. The authors conclude that early diagnosis and complete treatment of frontal sinusitis is crucial.

Pott puffy tumour in a five-year-old girl

“…4 The most commonly cultured organisms include Streptococcus, Staphylococcus, H. influenzae, Enterococcus and anaerobes such as Fusobacterium and Bacteroides. 2,4,7 Polymicrobial growth has also been reported. 4 Streptococcus anginosus, which was isolated in this case, has not been described in relation to the condition.…”

“…4,7 The typical description refers to a well-defined, tender and localized swelling of the forehead or scalp overlying the area of frontal osteomyelitis. 2,7 In some patients, neurologic examination shows abnormalities (e.g., hemiparesis, obtundation and focal neurologic deficits) secondary to the intracranial extension.…”

“…6 If an intracranial complication is suspected, magnetic resonance imaging (MRI) with gadolinium is the imaging modality of choice. 7 Sensitivity rates for CT and MRI in detecting intracranial abscesses are 92% and 100%, respectively. 7 A delay in imaging can delay appropriate treatment and increase the risk of complications, such as epidural and subdural abscesses, meningitis and venous sinus thrombosis.…”

“…7 Once the diagnosis is suspected, appropriately targeted intravenous antibiotics with good central nervous system penetration should be initiated after blood samples have been drawn for culture. The goals of neurosurgical treatment include evacuation of the subperiosteal abscess, removal of osteomyelitic bone and removal of granulation tissue.…”

Puffy Frontal Edema: A Serious Life-Threatening Finding of Pott’s Puffy Tumor: Case Report

“…1 Currently, it is defined as a forehead-localized swelling with overlying subperiosteal abscess and osteomyelitis of the frontal bone. [2][3][4][5] In this case report we presented a 13-year old male patient with Pott's puffy tumour to emphasize the importance of early diagnosis and early initiation of therapy in the development of morbidity and mortality.…”