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Patient presenting with frontal subperiosteal abscess and headache: a case of Pott's puffy tumour
1a Department of Neurosurgery , Gülhane Military Medical Academy, Haydarpaşa Teaching Hospital , Istanbul , Turkey.
Abstract:
Chronic sinusitis can be complicated with erosion of anterior or posterior wall of the sinus; causing Pott's puffy tumour in the anterior, or epidural abscess in the posterior communication. A 65-year old man with a painful swelling in his forehead is presented. Pott's puffy tumour was diagnosed. CT, MRI, and DTI studies were obtained. Epidural or dural involvement was not present. In the first operation, anterior wall of the frontal sinus wall was opened. Osteomyelitis debridement was performed and the frontonasal duct was enlarged endoscopically. Antibiotics were commenced and were continued for 6 weeks. In the second operation, nasal septum deviation was fixed. Postoperative course was uneventful. The presented case suggests that treatment of sinus osteomyelitis should comprise immediate surgical drainage and osteomyelitis debridement followed by long-term administration of antibiotics. MRI study with contrast should be obtained to rule out epidural abscess and dural infiltration.
Insights
Pott's puffy tumor, a complication of chronic sinusitis, requires prompt surgical drainage and debridement, followed by extended antibiotic therapy. Imaging is crucial to rule out deeper infections like epidural abscesses.
Area of Science:
- Otolaryngology
- Neurosurgery
- Radiology
Background:
- Chronic sinusitis can lead to severe complications, including Pott's puffy tumor (PPT) and epidural abscesses, due to sinus wall erosion.
- Pott's puffy tumor is an uncommon complication characterized by a subperiosteal abscess of the frontal bone, often associated with frontal sinusitis.
Observation:
- A 65-year-old male presented with a painful forehead swelling, diagnosed as Pott's puffy tumor.
- Diagnostic imaging included CT, MRI, and DTI, which confirmed the absence of epidural or dural involvement.
Findings:
- Surgical intervention involved debridement of osteomyelitis and endoscopic enlargement of the frontonasal duct.
- A second surgery corrected nasal septum deviation. The patient experienced an uneventful postoperative recovery.
Implications:
- This case underscores the importance of immediate surgical drainage and debridement for sinus osteomyelitis.
- Long-term antibiotic administration is essential for successful treatment. Contrast-enhanced MRI is vital for excluding epidural abscess and dural infiltration.
