Pott's Puffy Tumor in the Adult Population: Systematic Review and Meta-Analysis of Case Reports

Objectives: Pott's puffy tumor (PPT) is a rare and life-threatening infection of the frontal sinuses, predominantly affecting children but with less frequent reports in adults. Therefore, we present an analysis of one hundred and eighty-one cases of adult patients diagnosed with PPT, along with a description of one of our cases. The purpose of this research is to identify the most common symptoms, predisposing medical history, predominant microorganisms, commonly used antibiotics, treatment options, long-term outcomes, and possible complications in adults. Despite its rarity, PPT has a dynamic course, necessitating familiarization with appropriate treatment methods to improve patient well-being. Methods: Methods involved a systematic search of PubMed, Medline, Google Scholar, Web of Science, EBSCO, and Scopus, following PRISMA guidelines. A total of 122 articles were screened, providing 180 adult patients aged 18 to 86, alongside 1 additional patient treated at our institution, bringing the total to 181 patients. Results: The results showed that the patients ranged from 18 to 86 years of age (mean age of 47 years), with 72.2% being males. The most common symptoms were forehead swelling (74.7%), frontal headache (67%), fever (59.3%), and acute/chronic rhinosinusitis (39.6%). The risk factors associated with its development include sinusitis (49.5%) and previous head trauma (12.6%). Intracranial involvement was found in 38.1% of patients. Streptococcus spp. (19.3%) and Staphylococcus spp. (16.6%) were the most commonly identified pathogens. Surgical intervention was employed in 87.3% of cases, with a mean hospital stay of 23 days. There was no significant difference in hospital stay or rehospitalization rates between those with and without intracranial involvement. Antibiotic therapy was used in 87.3% of cases, with a mean duration of 61 days. A combination of Cephalosporin, Metronidazole, and Nafcillin was the most common empirical antibiotic therapy. The mean follow-up period was 14 months, with a mortality rate of 1.6%. Conclusions: The conclusion highlights the importance of the prompt initiation of empirical antibiotic therapy, followed by targeted treatment based on microbiological cultures. Recognizing that PPT symptoms are not exclusive to pediatric patients but can also affect adults is crucial. PPT warrants further research to optimize its management and outcomes. It is believed that PPT may be more treatable in adults when identified early, which emphasizes the need for PPT recognition among adults. Timely empirical antibiotics based on microbiological results, along with appropriate surgical intervention, are critical for improving outcomes. Multidisciplinary care involving otolaryngologists, neurologists, and infectious disease specialists is essential. Further studies should be developed for the evaluation of diagnostic protocols and long-term management strategies.