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Pott's Puffy Tumor in Young Age: A Systematic Review and Our Experience
Antonio Daloiso1, Tiziana Mondello1, Francesco Boaria2
1Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy.
Abstract:
Background: Pott's Puffy Tumor (PPT) in young-age patients is a rare clinical entity characterized by osteomyelitis of the frontal bone with a subperiosteal abscess collection. Previous reviews primarily consist of small, retrospective case series and anecdotal reports. This study aims to present the largest, most up-to-date systematic review of essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches for managing PPT in pediatric and adolescent populations. Methods: PubMed, Scopus, and Web of Science databases were systematically screened until 3 January 2024. The protocol of this investigation was registered on PROSPERO in January 2024, and the systematic review was performed according to the PRISMA statement. The study included 184 patients from 109 articles and an additional case from the authors' institution. Results: PPT commonly stems from untreated rhinosinusitis, respectively, acute pansinusitis, frontal acute rhinosinusitis and chronic rhinosinusitis, and direct head trauma. Infections typically involve a polymicrobial anaerobe-predominant microbiome. Computed tomography and magnetic resonance imaging are routinely used for presurgical assessment and posttreatment surveillance. Intracranial complications were significantly associated with the type of surgical treatment (p value < 0.0001). Conclusions: PPT is a significant and relatively morbid disease often under-recognized and misdiagnosed due to its variable clinical presentation. Management includes both antimicrobial therapy and surgical intervention, emphasizing the importance of an interdisciplinary approach.
Insights
Pott's Puffy Tumor (PPT) is a rare frontal bone infection in young patients, often caused by sinusitis. Prompt diagnosis and combined antibiotic and surgical treatment are crucial for managing this condition.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Neurosurgery
Background:
- Pott's Puffy Tumor (PPT) is a rare osteomyelitis of the frontal bone with a subperiosteal abscess.
- Previous reviews are limited to small case series, necessitating a comprehensive update.
Purpose of the Study:
- To conduct the largest systematic review on Pott's Puffy Tumor in pediatric and adolescent populations.
- To consolidate data on clinical presentation, diagnostics, microbiology, and treatment.
Main Methods:
- Systematic screening of PubMed, Scopus, and Web of Science databases until January 2024.
- Adherence to PRISMA statement guidelines for systematic reviews.
- Inclusion of 184 patients from 109 articles plus one additional case.
Main Results:
- Common causes include untreated rhinosinusitis and head trauma.
- Infections are typically polymicrobial with a predominance of anaerobes.
- Imaging (CT/MRI) is vital for assessment; intracranial complications correlate with surgical treatment type (p < 0.0001).
Conclusions:
- PPT is often under-recognized due to variable presentation, posing significant morbidity.
- Effective management requires a combination of antimicrobial therapy and surgical intervention.
- An interdisciplinary approach is essential for optimal patient outcomes.
