Pott's puffy tumor. A condition still to be considered

Area of Science:

• Pediatric Otolaryngology
• Neuroimaging in Sinusitis
• Infectious Disease Complications

Background:

• Pott-Puffy Tumor (PPT) is a rare complication of acute bacterial rhinosinusitis, characterized by frontal bone osteomyelitis and subgaleal abscess.
• While uncommon in the antibiotic era, PPT requires prompt diagnosis and management to prevent serious intracranial complications.

Observation:

• An 11-year-old female presented with a week of headache and fever, followed by 3 days of frontal swelling.
• Physical examination revealed fever, nasal congestion with discharge, and a tender frontal swelling without fluctuation.
• Computed tomography (CT) of the brain and paranasal sinuses showed pansinusitis with an epidural collection in the right frontal region and a corresponding extracranial fluid collection.

Findings:

• CT imaging confirmed pansinusitis (maxillary, left ethmoid, frontal sinuses) and a right frontal epidural collection with enhancement.
• The patient underwent bilateral maxillary antral washout and left frontal sinus trephination.
• These procedures led to complete resolution of her symptoms.

Implications:

• Minimally invasive surgical interventions like antral washout and sinus trephination can effectively manage Pott-Puffy Tumor.
• Early diagnosis and treatment can prevent the need for more aggressive surgical interventions and potential intracranial spread.
• This case highlights the importance of considering rare complications of sinusitis even in the current antibiotic era.