Pott's puffy tumor in pediatric age group: A retrospective study

Abstract

ObjectiveTo study the etiology, clinical features and treatment outcomes of pediatric Pott's puffy tumor (PPT). MethodsThis retrospective study was carried by reviewing medical case record of pediatrics PPT cases admitted to our hospital from January 2010 to august 2011. Data regarding the patient's demographic details, presenting symptoms and signs, etiology, laboratory findings, imaging findings, management, complications and outcomes of treatment were collected and analyzed. ResultsA total of five cases of PPT were found. Three were male and two were female with a mean age of 11.6 years. All patients presented with headache, fever and tender forehead swelling. Nasal polyps and discharging sinuses over forehead were present in one case and one case had preseptal orbital cellulites in addition to PPT. None of the patient had intracranial complications. Three cases (60%) were secondary to acute frontal sinusitis, one case was as complication of chronic sinusitis and one case was because of trauma. Contrast enhanced Computerized tomography (CECT) demonstrated features of acute sinusitis in 3 cases, sinonasal polyp in one, fracture of anterior table of frontal bone in one case, subperiosteal collection and erosion of anterior table frontal bone in all cases. All patients required surgical intervention; Endoscopic approach 2 cases (40%), combined approach in 2 cases (40%) and external approach in one case (20%) in addition to aggressive antibiotic treatment. There was purulent discharge in frontal sinuses in all cases.In 2 cases (40%), culture of pus drained during surgery was positive; one case methicillin resistant Staphylococcus aureus sensitive to vancomycin, other Pseudomonas aeruginosa sensitive to ceftazidime and amikacin. All cases improved with treatment. There were no postoperative complications or facial cosmetic deformity except facial scar in three cases. The average hospital stay was two weeks and ranged from 10 days to 21 days. All patients received antibiotics for 6–8 weeks to treat osteomyelitis of the frontal bone. The average length of follow up was 9 months (range 6–18 months). All patient are doing well and are under regular follow up. ConclusionsPPT is a complicated infection of frontal sinusitis and trauma that requires broad spectrum antibiotics and surgical treatment. Diagnosis is made by high clinical suspicion of this condition and confirmed by CECT. Early treatment results in favorable outcomes and decreases the risk of further complications.