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Pott's puffy tumor in pediatric Patients: Our surgical experience
Udi Shapira1, Fares Butrus1, Nidal Muhanna1
1Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Insights
Pott's puffy tumor (PPT) in children requires prompt treatment with antibiotics and surgery. While endoscopic sinus surgery is advancing, open approaches remain crucial for effective PPT management and to reduce reoperation rates.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Infectious Diseases
Background:
- Pott's puffy tumor (PPT) is a rare, serious complication of frontal sinusitis.
- It involves subperiosteal abscess and osteomyelitis of the frontal sinus.
- Prompt treatment including surgical drainage and antibiotics is essential.
Purpose of the Study:
- To report surgical experience with pediatric Pott's puffy tumor.
- To evaluate different surgical approaches for PPT.
- To assess outcomes and reintervention rates.
Main Methods:
- Retrospective review of 13 pediatric patients with PPT (2018-2023).
- Evaluation of clinical, laboratory, radiology, and surgical data.
- Analysis of surgical approaches: trephination, endoscopic sinus surgery (ESS), and combined.
Main Results:
- 12 of 13 patients underwent surgery; 8 had intracranial complications.
- Surgical approaches included trephination (25%), ESS (41.66%), and combined (33.33%).
- 5 patients required reoperation; endoscopic drainage alone had higher reintervention risk.
Conclusions:
- PPT management necessitates antibiotics and surgical intervention.
- Open approaches remain vital for PPT treatment.
- Combined or open approaches may offer better outcomes than solely endoscopic drainage, reducing reoperations.
Background:
Pott's puffy tumor (PPT) is a rare complication of frontal sinusitis defined as subperiosteal abscess of the anterior table of the frontal sinus with associated osteomyelitis. Its complications can be harmful to the patient, therefore immediate treatment is necessary. Surgical drainage and systemic antibiotics are considered as integral parts of the overall treatment. However, surgical approaches can differ between different centers and surgeons.
Methods:
We retrospectively evaluated the electronic records of 13 pediatric patients with PPT between 2018 and 2023.Clinical, laboratory radiology, and demographic findings were evaluated as well as surgical and post op data.
Results:
Thirteen patients were included in the study (M/F: 7/6), the median age was 11.3 (6-15) years old. eight (61.5 %) patients had an intracranial complication. All patients were treated with intravenous antibiotics. One patient was treated conservatively and the other 12 were operated on. In the first operation 3/12 (25 %) underwent only frontal sinus trephination, 5/12 (41.66 %) underwent endoscopic sinus surgery (ESS) and 4/12 (33.33 %) underwent combined endoscopic and trephination surgery. Repeated surgery was needed for 5 patients, four of them underwent only endoscopic drainage and one underwent combined endoscopic and trephination surgery. The media hospitalization time (days) after the 1st surgical intervention was 8.3 for the combined approach, 9.6 for the external approach and 14.75 for the endoscopic approach. All patients recovered uneventfully.
Conclusions:
Herein, we report our surgical experience in pediatric patients with PPT treated in a tertiary hospital. Ideally, PPT should be managed with a combination of broad-spectrum antibiotic therapy and surgical intervention. Traditionally, open approaches served as the primary surgical route to access frontal sinus in PPT patients. However, the emergence of endoscopes instrumentation has supplemented these approaches in dealing with PPT. Our database reveals that open approach still has an important role in PPT treatment as patients who underwent only endoscopic drainage faced a higher risk of inadequate improvement and necessitating reintervention.
