Puffy Tumor Research Articles

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

Pott's puffy tumor (PTT) is a frontal subperiosteal abscess associated with underlying frontal osteomyelitis. The purpose of the present study was to assess the rate of intracranial involvement in pediatric and adolescent patients with PPT and to discuss the diagnostic workup and the therapeutic features of this pathology. We searched Web of Science, PubMed and MEDLINE from 1998 to 2018. The search focused on papers concerning the diagnostic procedure and therapeutic management of PTT. Statistical techniques were not used. We included 53 articles that described 92 pediatric and adolescent patients with PPT. The overall rate of intracranial complications was found to be 72%. Most authors used computed tomography for the diagnosis of PTT and its complications, either alone or in combination with magnetic resonance imaging. In 50% of cases, an endoscopic endonasal approach is used for the management of the underlying acute or chronic sinusitis. On the basis of the available literature, it seems that the incidence rate of intracranial involvement in patients with PPT is quite high. Early diagnosis using the appropriate imaging raise the possibility of good recovery. Concerning the therapy of PTT, endoscopic sinus surgery could be considered as a valuable technique. The vast majority of patients treated appropriately recover without long-term neurologic complications and sequelae. 4 Laryngoscope, 130:225-231, 2020.

The Microbiology of Complicated Acute Sinusitis among Pediatric Patients: A Case Series.

The microbiology of pediatric complicated acute rhinosinusitis (ARS) has evolved, and our current understanding of pathogenic organisms is limited. The objectives of this study are to describe the incidence of pathogens causing complicated ARS requiring surgical intervention at our institution over a 10-year period as well as their associated treatment outcomes. Retrospective cohort study. A single tertiary care children's hospital. Data were reviewed from all patients who underwent surgery for complicated ARS and had positive culture data from 2006 to 2016. Associations among pathogens, complications, and outcomes were analyzed with Pearson χ2 and Wilcoxon rank-sum tests. Eighty-nine patients met criteria. Complications included orbital infections (78%), intracranial infections (48%), Pott's puffy tumor (13%), and cavernous sinus thrombosis (9.0%). Bacterial isolates were majority polymicrobial (55%) and included Streptococcus species (58%), Staphylococcus species (49%; including methicillin-resistant S aureus [MRSA], 11%), and anaerobic bacteria (35%). S pneumoniae (9.0%), Haemophilus species (4.5%), and Moraxella catarrhalis (1.1%) were relatively uncommon. Bacterial isolates were similar among patients with all types of complications. Among a large cohort of pediatric patients with complicated ARS, most bacterial isolates were polymicrobial, with Streptococcus and Staphylococcus species contributing to the majority of cases. S aureus species, including MRSA and anaerobic pathogens, were common. The pattern of bacterial isolates was similar among patients with all types of complications of ARS. We suggest treatment for complicated ARS with broad-spectrum antibiotics with coverage for Streptococcus species, Staphylococcus species including MRSA, and anaerobic bacteria.

Paranasal sinusitis complicated by Pott’s puffy tumour

Paranasal sinusitis complicated by Pott’s puffy tumour

Pott’s puffy tumour secondary to frontal sinusitis

Frontal sinusitis is a common encounter in otorhinolaryngology practice. Most patients will present with frontal headache which worsens on bending forward, reduced sense of smell and sometimes cacosmia. Pott’s puffy tumour is an osteomyelitis of the frontal bone, which was originally described as a result of trauma, but it can also develop as a result of frontal sinusitis. We present a rare case of a rapidly progressing Pott’s puffy tumour involving the frontal sinus. The oedema subsided after antibiotic treatment and the patient underwent functional endoscopic sinus surgery.

Lethal complication in Pott's Puffy tumor: A case report

Abstract A man in his fifties was found dead in his bed. Using postmortem CT, the frontal sinus wall was seen to have been destroyed and a subcutaneous / intra-cranial mass-like lesion was detected. Postmortem blood biochemical examination demonstrated high values of urea nitrogen, c-reactive protein, procalcitonin, and precepsin, which were thought to be due to sepsis. Needle aspiration showed reddish viscous fluid, and the presence of Klebsiella oxytoca was confirmed by culture inspection. Based on these results, Pott's puffy tumor with intracranial empyema, and dehydration with sepsis in the agonal period was assessed as the cause of death. Using autopsy evaluation, it was possible to come to a concrete conclusion, but a minimally invasive autopsy might be an alternative approach to investigate the cause of death.

Atypically Located Pott’s Puffy Tumor Presenting as Epidural-Cutaneous Fistula

Atypically Located Pott’s Puffy Tumor Presenting as Epidural-Cutaneous Fistula

Endoscopic management of Pott's puffy tumour - Still a common entity in-developing country a case series of three patients: Our experience

Abstract Pott's puffy tumour is a lesser known clinical entity usually seen as complication of frontal sinusitis or trauma to frontal bone. Patients typically present with fluctuant swelling of the frontal region. It can lead to significant morbidity if not diagnosed and treated promptly. We herein present a series of three cases with diagnosis of Pott's puffy tumour, two cases following acute bacterial frontal sinusitis and third case presenting as complication of allergic fungal sinusitis. We discuss the presentation, diagnostic and treatment of Pott's puffy tumour.

Not Your Typical Preseptal Cellulitis: A Case Report Of Pott’s Puffy Tumor

Pott’s puffy tumor (PPT) is defined as a subperiosteal abscess and osteomyelitis of the frontal bone that occurs as a rare complication of trauma or acute sinusitis. Most common presenting symptoms include headache, fever, rhinitis, local tenderness and nasal obstruction. While initially thought to be a rare entity, PPT appears to be occurring with increasing frequency with most complications managed surgically. We present a 14 year-old girl who presented with an initial diagnosis of preseptal cellulitis that failed both oral and intravenous antibiotics. Repeat imaging revealed a frontal bone subperiosteal abscess and osteomyelitis, without intracranial extension and was successfully managed medically without surgical intervention.

Pott's Puffy tumor: The role of ultrasound, computed tomography and magnetic resonance imaging in diagnosis

Pott’s Puffy tumor is a rare disorder which is charactarized by frontal osteomyelitis and subperiosteal abscess as a complication of sinusitis. Nowadays we have forgotten this entity under the broad spectrum antibiotherapies for sinusitis. We reported an adolescent with chronic sinusitis suffered from forehead swelling and headache. He was performed ultrasound, computed tomography, magnetic resonans imaging for accurate diagnosis. Early diagnosis with appropriate imaging is necessary in order to avoid more severe complications, such as subdural empyema, septic thrombosis of the dural sinuses. Emergency physicians should remember Pott’s puffy tumor in differential diagnosis in patients presenting with forehead swelling and headache. Imaging modalities have an important role for the right diagnosis and guidance of the surgery. The thing that make this report special is the ultrasonographic images that are so rare reported in the literature. To our knowledge there are two reports which emphasized the sonographic findings of this entity.

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

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). Literature PubMed review using a combination of MeSH terms and keywords was undertaken, combined with a single surgeon case series of 3 patients. 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. 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.

Pott Puffy Tumor

Pott puffy tumor is osteomyelitis of the frontal bone with associated subperiosteal abscess causing swelling and edema over the forehead and scalp. It is a complication of frontal sinusitis or trauma. We present the case of an 8-year-old girl with frontal swelling. Imaging evaluation showed frontal osteomyelitis as a complication of frontal sinusitis with associated epidural and subperiosteal abscess. The patient was treated surgically and recovered well. This case highlights the need for high clinical suspicion and early diagnosis and management to prevent life-threatening complications. Unfortunately, in our case the patient had to undergo surgery for this complication, which could have been prevented by earlier diagnosis.

Endoscopic Sinus Surgery in Acute and Chronic Pediatric Rhinosinusitis

Submit Manuscript | http://medcraveonline.com their quality of life [3]. Hence, the fact remains that some children, who do not respond to medical treatment, will be referred to the Otorhinolaryngologist, who, in turn, faces the problem of what to recommend. Part of the problem is lying upon the discrepancy in opinions between Otorhinolaryngologist and Pediatricians, regarding the indications for sinus surgery, especially in chronic cases, which can be frequently, summarized in the quote “in chronic sinusitis every effort should be made to avoid operative procedures” [4]. This discrepancy necessitates the least possible variance in the proposed treatment plan by the Otolaryngologist, and his/her adherence to the principles of evidence-based medicine in this domain also, disregarding any dogmatic views. With regard to acute rhinosinusitis, endoscopic sinus surgery is usually reserved for the management of pending or existing complications. Osteomyelitis of the anterior frontal plate (Pott’s puffy tumour) represents such a condition, and should be managed in the majority of cases with an endoscopic frontal sinusotomy (Draf 2a). The procedure should include uncinectomy and middle meatal antrostomy, and complete anterior and posterior ethmoidectomy using the lamina papyracea and skull base as landmarks. The agger nasi as well as any frontal sinus cells obstructing the frontal recess should also be removed [5]. Neurosurgical intervention for the drainage of a co-existing intracranial abscess should be performed in the same session as the endoscopic nasal drainage, when possible [5]. Orbital complications represent the most frequently encountered complications of acute rhinosinusitis, appearing approximately twice as often as the intracranial ones, and followed by osseous involvement (osteomyelitis) [6]. Surgical intervention, preferably endoscopic, is advocated in cases of documented subperiosteal or intraorbital abscess, reduced visual acuity or color vision, affected afferent pupillary reflex or inability to assess the child’s vision. In addition, progressing or not improving orbital signs (diplopia, ophthalmoplegia, proptosis, swelling and chemosis) after 48 hours of intravenous antibiotics, or even progressing or not improving general condition of the child during the same time period also represent indications for prompt surgical exploration and drainage [6]. The procedure usually includes uncinectomy and middle meatal antrostomy, and anterior ethmoidectomy. Skeletonization of the lamina papyracea following probing, and drainage of the subperiosteal or intraorbital pus collection are also required in case of respective abscess formation. By contrast, surgical drainage could be withheld in children aged between 2-4 years old or less with small (< 0.5-1 ml in volume) medially located subperiosteal abscess, demonstrating clear clinical improvement within 24-48 hours of intravenous antibiotics, no decrease in visual acuity, and no significant systemic involvement [7]. As far as chronic rhinosinusitis is concerned, it has become clear in the modern era of endoscopy and imaging that rhinitis and adenoid hypertrophy are not the only reasons of a runny nose in children, as in the majority of cases the sinuses are involved as well. Hence, chronic rhinosinusitis may often be overlooked. Irrespective of difficulties in diagnosis associated with the variability in the clinical presentation of chronic pediatric rhinosinusitis, and/or the frequent inability of children to reliably describe their exact symptoms, chronic rhinosinusitis may have a serious impact on children’s quality of life, and their respective health status.

Pott Puffy Tumor in Children: A Rare Emergency Clinical Entity.

Pott puffy tumor (PPT) is defined as soft tissue swelling of the forehead due to subperiosteal edema, accumulation of pus, or granulation tissue. It is associated with osteomyelitis of frontal bone secondary to frontal sinusitis. Pott puffy tumor can be complicated by preseptal and orbital cellulitis and intracranial infection. Six patients diagnosed with and treated for PPT in Pediatric Clinic of Uludag University Faculty of Medicine from 2010 to 2015 were reviewed retrospectively. Age, sex, presenting symptoms and signs, laboratory and radiological findings, as well as intracranial complications and treatment modalities of all patients were evaluated. The authors present 6 pediatric patients of PPT, 5 males and 1 female with a mean age of 11 years (age range, 7-18 years). All patients presented with headache, fever, and tender frontal swelling. Two of the patients had epidural abscess and 1 had preseptal orbital cellulitis in addition to PPT. All of them had computed tomography scan and/or magnetic resonance imaging. Endoscopic sinus surgery was performed in 4 patients and 2 patients underwent neurosurgical intervention with antibiotherapy. Pott puffy tumor may be associated with potentially dangerous intracranial complications. Early diagnosis and treatment are essential to reduce morbidity and mortality. Imaging plays an important role in the diagnosis of the disease and the detection of its complications.

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

IntroductionOsteomyelitis 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 reportThe authors report the case of a 34-year-old man with Pott's puffy tumour following trauma to the frontal sinus. DiscussionThe diagnosis was suggested clinically and confirmed radiologically. Treatment was surgical with craniotomy and external drainage.

Pott’s Puffy tumor and intracranial complication developing secondary to acute frontal sinusitis: A case report

Pott’s Puffy tumor and intracranial complication developing secondary to acute frontal sinusitis: A case report

Pott's puffy tumor due to Aspergillus fumigatus

Pott's puffy tumor (PPT) is a very rare, nearly forgotten condition. We describe a 9-year-old girl with PPT due to trauma and surgical cultures that revealed Aspergillus fumigatus.

Hospital cost of pediatric patients with complicated acute sinusitis

ObjectiveReview costs for pediatric patients with complicated acute sinusitis. MethodsA 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. ResultsThe 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. ConclusionAlthough 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.

Pediatric sinogenic epidural and subdural empyema: The role of endoscopic sinus surgery

AimTo analyze the indications and outcomes of open neurosurgical approaches (ONA) and endoscopic transnasal approaches (ETA) in the surgical management of pediatric sinogenic subdural and epidural empyema. Material and methodsRetrospective single-center study design within a tertiary care referral center setting. Children less than 18 years of age consecutively operated on between January 2012 and February 2014 for drainage of a sinogenic subdural empyema (SE) or epidural (EE) empyema were included. Main outcome measures: success of first surgical procedure, persistent symptoms and sequelae at the end of the follow-up period. ResultsNine SE (53%) and 8 EE (47%) were observed. Neurological symptoms, especially seizures, were more frequent in the SE group. Perioperative pus samples were positive in 67% of the SE group and in 75% of the EE group. The most frequently isolated bacteria belonged to the Streptococcus anginosus group. CT or MR imaging showed that most empyema probably originated from the frontal sinus. However, two cases resulted from an ethmoiditis and one case from a Pott's puffy tumor, without any direct contact with the paranasal sinus. In cases of SE, the most effective surgical technique was ONA with craniotomy. Associated endoscopic sinus drainage was useful for the purpose of bacteriological diagnosis. In cases of EE, effectiveness was noted in both ONA and ETA techniques. In two cases of EE, the ETA procedure encompassed direct drainage of the empyema through the posterior wall of the frontal sinus (Draf III approach). The number of patients successfully treated after a single surgical procedure was higher in the EE group (p=0.05). Regarding outcomes, no mortalities were observed. Persistent disorders at the end of the follow-up period, especially headaches, cognitive, concentration or schooling problems, tended to be more frequent in the SE group than in the EE group (67% vs 29%), and were more commonly observed in cases requiring several surgical procedures (75% vs 12.5%) (p=0.05). DiscussionEndoscopic sinus surgery plays a critical role in the surgical management of pediatric sinogenic SE and EE. In cases of small volume EE, the endoscopic approach associated with antibiotherapy may be sufficient to treat the infectious process.

Isolated frontal sinus aspergillosis – Presenting as ‘Pott’s puffy tumor’

Isolated frontal sinus aspergillosis is extremely uncommon. Frontal sinus is commonly involved secondarily in association with other sinuses. A case of isolated frontal sinus aspergillosis is being reported which presented as Pott’s puffy tumor. Frontal sinus exploration was done under general anesthesia. A small focus of the osteomyelitic bone in the anterior wall of the frontal sinus was removed. The fungus ball filling the left frontal sinus was removed.

Diffuse Large B-Cell Lymphoma of the Frontal Sinus Presenting as a Pott Puffy Tumor: A Case Report

Objective: Sinonasal non-Hodgkin lymphoma (NHL) is a very rare condition. NHL located specifically in the frontal sinus is an extremely rare condition with only 14 cases in the literature reported to date. A unique case of diffuse large B cell lymphoma of the frontal sinus who presented first and was treated as suspected Pott Puffy Tumor is presented along with a review of the literature.