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Pott Puffy Tumor in Adults: The Τiming of Surgical Ιntervention
Giorgos Sideris1, Alexander Delides2, Konstantinos Proikas1
12nd ENT Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC.
Abstract:
Pott's puffy tumor (PPT) represents a rare complication of frontal sinusitis, and it is considered as a subperiosteal abscess of the frontal bone based on osteomyelitis. We report two adult PPT patients and discuss the treatment plan as well as the correct timing of surgical intervention. Clinical examination revealed sinusitis with puss, and imaging findings showed bony erosion of the dorsal wall of the frontal sinus in both patients. In case 1, a "wait and see" approach was followed with remission of the patient's symptoms, and a Draf IIb type was performed 21 days after discharge. In case 2, worsening of symptoms led to surgical drainage through a Lynch incision followed by 20 days of intravenous antibiotic treatment. Then a Draf type IIa was performed. Both patients received antibiotic therapy over the course of six weeks and had full recovery. We highlight the importance of the correct timing of surgical intervention as it is depended on the clinical and radiological findings. The timing to performing radical drainage surgery including external or endoscopic frontal sinus surgery is not determined in the literature. Worsening of common symptoms and neurological signs in adult PPT patients means by default an immediate surgical intervention. Reduction of symptoms and antibiotic treatment response means that surgery should be delayed and performed in a surgical field free of inflammation.
Insights
Pott's puffy tumor (PPT), a complication of frontal sinusitis, requires careful surgical timing. Delayed intervention is favored with symptom improvement and antibiotic response, while worsening signs necessitate immediate surgery.
Area of Science:
- Otolaryngology
- Neurosurgery
- Infectious Diseases
Background:
- Pott's puffy tumor (PPT) is a rare subperiosteal abscess of the frontal bone, often stemming from frontal sinusitis and osteomyelitis.
- Optimal surgical timing for PPT remains debated in medical literature.
Observation:
- Two adult patients with PPT presented with sinusitis and frontal bone erosion.
- Case 1: Managed conservatively with delayed endoscopic sinus surgery (Draf IIb) after symptom remission.
- Case 2: Required immediate surgical drainage via Lynch incision followed by antibiotics and later endoscopic sinus surgery (Draf IIa).
Findings:
- Both patients recovered fully after six weeks of antibiotic therapy and appropriate surgical intervention.
- Clinical and radiological findings are crucial for determining the correct timing of surgical intervention.
- Conservative management with delayed surgery can be effective when symptoms improve with antibiotics.
Implications:
- Worsening symptoms or neurological signs in adult PPT patients indicate a need for immediate surgical intervention.
- Reduced symptoms and positive response to antibiotics suggest delaying radical drainage surgery until the inflammatory field is clear.
- This case series emphasizes individualized treatment strategies based on patient presentation and response.
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