Pott's puffy tumor: aneed for interdisciplinary diagnosis and treatment.

Stefan Linsler,Nasenien Nourkami-Tutdibi,Jan Philipp Kühn,Sören L Becker,Philipp Kulas,Alessandro Bozzato,Sascha Meyer,Umut Yilmaz,Bernhard Schick

doi:10.1007/s00106-021-01134-w

Stefan Linsler, Nasenien Nourkami-Tutdibi + Show 7 more

Open Access

https://doi.org/10.1007/s00106-021-01134-w

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Abstract

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.

Highlights

Pott’s puffy tumor (PPT) is a rare phenomenon, characterized by localized forehead swelling, which was first described by Sir Percival Pott in the eighteenth century as an abscess formation and extradural empyema in relation to frontal head trauma [7]
Most bacteria found in PPT correspond to community-acquired sinusitis such as Streptococcus spp., Staphylococcus spp., Haemophilus influenzae, Klebsiella spp., anaerobes and enterococci, with staphylococci being the most common agents
Pott’s puffy tumor can be found in all age groups. It predominantly occurs in adolescents with a developed frontal sinus due to a higher incidence of upper respiratory tract infections and an increased risk of acute bacterial sinusitis [9]

Summary

Introduction

Pott’s puffy tumor (PPT) is a rare phenomenon, characterized by localized forehead swelling, which was first described by Sir Percival Pott in the eighteenth century as an abscess formation and extradural empyema in relation to frontal head trauma [7]. A 19-year-old male patient presented to our clinic with an acute right orbital and forehead swelling. He had recently undergone an alio loco endonasal operation because of similar symptoms 20 days earlier. Laboratory results showed a slightly elevated CRP level of 30.3 mg/l and a WBC of 10.1 Both the MRI and CT studies revealed sinusitis with frontal osteomyelitis accompanied by an epidural and subgaleal abscess formation without intracranial involvement

Discussion

Practical conclusion