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Published on: December 9, 2022
Pott's puffy tumor: A comprehensive review of the literature
Rebecca L Rohde1, Lauren M North1, Molly Murray2
1Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America; Zablocki Veteran's Association Medical Center, Division of Surgery, Milwaukee, WI, United States of America.
Purpose:
Pott's puffy tumor (PPT) is a rare clinical entity characterized by osteomyelitis of the frontal bone with subperiosteal abscess collection. The frequency of reported cases of PPT in the literature has increased in recent years. Previous reviews of PPT exist primarily in the form of small, retrospective case series and anecdotal case reports. Therefore, the aim of this study is to provide the literature's largest comprehensive, up-to-date review of the essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches utilized in the management of PPT, both in pediatric and adult populations.
Materials And Methods:
We searched MEDLINE, PubMed, and Embase databases for English-language studies published from January 1950 through January 30, 2022. The authors reviewed all cases of PPT, focusing specifically on those describing therapeutic management of PPT. A total of 321 patients were included, consisting of 318 patients (from 216 articles) and an additional 3 adult cases from our institution.
Results:
PPT most often results from untreated rhinosinusitis, as well as direct head trauma, substance use, and odontogenic disease. Infections are classically polymicrobial with an anaerobe-predominant microbiome. Both CT and MRI imaging modalities are commonly obtained for presurgical assessment of sinusitis and intracranial extension. The core of treatment is an early and aggressive approach to prevent long-term complications. A significant association exists between surgical management and clinical outcomes for patients with PPT. Recent literature suggests endoscopic sinus surgery is essential for successful disease resolution.
Conclusions:
PPT is an important and relatively morbid disease process that is often underrecognized and misdiagnosed at presentation due to its variable clinical presentation. Management of PPT includes both antimicrobial therapy and surgical intervention. Determination of the optimal approach depends on patient clinical features including age, history of prior endoscopic sinus surgery, and presence of intracranial involvement on presentation. An individualized, targeted, and interdisciplinary approach to the treatment of PPT is critical for successful disease resolution.
Insights
Pott's puffy tumor (PPT) is a rare but serious condition. Early diagnosis and aggressive treatment, including surgery, are crucial for successful outcomes in patients with this frontal bone osteomyelitis.
Area of Science:
- Otolaryngology
- Neurosurgery
- Infectious Disease
Background:
- Pott's puffy tumor (PPT) involves frontal bone osteomyelitis and subperiosteal abscesses.
- Recent literature shows an increasing frequency of reported PPT cases.
- Existing reviews are limited to small case series or reports.
Purpose of the Study:
- To conduct the largest comprehensive review of Pott's puffy tumor.
- To detail clinical findings, diagnostics, microbiology, and treatment.
- To cover both pediatric and adult populations.
Main Methods:
- Searched MEDLINE, PubMed, and Embase (1950-2022).
- Reviewed English-language studies focusing on PPT therapeutic management.
- Included 321 patients (318 from literature, 3 from institution).
Main Results:
- PPT commonly arises from untreated rhinosinusitis, trauma, substance use, or odontogenic disease.
- Infections are typically polymicrobial, often with anaerobic predominance.
- CT/MRI aid presurgical assessment; early, aggressive treatment, especially endoscopic sinus surgery, improves outcomes.
Conclusions:
- PPT is underrecognized due to variable presentation, posing significant morbidity.
- Management requires both antimicrobial therapy and surgical intervention.
- An individualized, interdisciplinary approach based on patient factors is critical for resolution.
