Pott Puffy Tumor
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Michael S. Morris
A 55-year-old woman with recurrent sinusitis and nicotine dependence presented to the family practice clinic with a 1-month history of progressive, soft, well-demarcated swelling of the forehead (image A) associated with frontal headache and nasal congestion. Noncontrast craniofacial computed tomographic scan revealed an abscess eroding through the anterior frontal sinus (image B). Bedside 19-guage needle decompression produced 12 mL of purulent fluid. A loading dose of 3 g empirical ampicillin-sulbactam therapy was delivered intravenously (IV) followed by 1.5 g IV every 6 hours and 2 g of ceftriaxone IV every 24 hours. Although aerobic cultures showed no growth, anaerobic cultures demonstrated gram-negative rods with insufficient growth for identification. Pott puffy tumor (PPT) was diagnosed. Definitive surgical and medical management included an endoscopic left frontal and maxillary sinus operation with balloon sinuplasty, left anterior ethmoidectomy with frontal stent placement, and 875 to 125 mg of amoxicillin-clavulanate taken orally every 12 hours for 7 days after hospital discharge. At 6 weeks, PPT recurred and resolved after repeated endoscopic drainage and ertapenem 1 g IV daily for 6 weeks.
A subperiosteal abscess of the frontal bone, PPT appears as a localized swelling of the forehead associated with frontal osteomyelitis.1 Risk factors include frontal sinusitis, type 2 diabetes mellitus, craniofacial trauma, and intranasal cocaine administration.1 Common pathogens include Streptococcus and Staphylococcus organisms.1 Pott puffy tumor is associated with a high risk of meningitis, intracranial abscess, and venous sinus thrombosis.2 Successful treatment usually involves surgical debridement followed by 4 to 6 weeks of antimicrobial therapy.1,2
References
1. Akiyama K , KarakiM, MoriN. Evaluation of adult Pott's puffy tumor: our five cases and 27 literature cases. Laryngoscope. 2012;122(11): 2382-2388. doi:10.1002/lary.23490Search in Google Scholar PubMed
2. Kombogiorgas D , SolanskiGA. The Pott puffy tumor revisited: neurosurgical implications of this unforgotten entity. case report and review of the literature. J Neurosurg. 2006;105(2 suppl):143-149. doi:10.3171/ped.2006.105.2.143Search in Google Scholar PubMed
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