Intracranial Complications of Frontal Sinusitis in Children: Pott’s Puffy Tumor Revisited

Abstract

The objective of the present study is to describe the diagnosis and treatment of intracranial complications of frontal sinusitis (Pott’s puffy tumor) in a series of pediatric patients at our institution. A rare entity, Pott’s puffy tumor has been reported in only 21 pediatric cases in the literature of the antibiotic era. The hospital records and radiographic files at Rainbow Babies and Childrens Hospital, Cleveland, Ohio, USA, over the previous 16 years were retrospectively reviewed in a search for patients with the diagnosis of Pott’s puffy tumor, defined as scalp swelling and associated intracranial infection. There were 6 male patients and 1 female patient. Ages ranged from 11 to 18 years (median 14.5 years). Intracranial infections consisted of epidural abscess in 5 patients, subdural empyema in 4 and brain abscess in 1. Intraoperative cultures grew anaerobic organisms in 1 patient, microaerophilic streptococcus in 5 patients, Klebsiella species in 1 patient and Streptococcus pneumoniae in another. All patients presented with frontal scalp swelling, and other common symptoms included headache, fever, nasal drainage and frontal sinus tenderness. Five patients were treated with antibiotics prior to their presentation. Four patients presented with neurologic decompensation characterized by varying degrees of hemiparesis, obtundation, pupillary dilatation or aphasia. All patients underwent craniotomy and evacuation of the intracranial infection. Even severely impaired patients demonstrated full neurologic recovery. Despite the widespread use of antibiotics, neurosurgical complications of sinusitis continue to occur. A high degree of suspicion, along with prompt neurosurgical intervention and the use of appropriate antibiotics, can result in favorable outcomes in even the sickest patients.

A 14-Year-Old Male with Swelling of the Forehead

“…Pott's puffy tumor is most frequently a complication of an underlying frontal sinusitis. [1][2][3][5][6][7][8][9] The pneumatization of frontal sinuses starts by age 2 years, and it is well formed by ages 12 to 13 years. 3,5 Direct spread of infection from the frontal sinus to the frontal bone anteriorly may erode the cortex and lead to collection of pus below the periosteum leading to a swelling known as Pott's puffy tumor.…”

“…[1][2][3][5][6][7][8][9] The pneumatization of frontal sinuses starts by age 2 years, and it is well formed by ages 12 to 13 years. 3,5 Direct spread of infection from the frontal sinus to the frontal bone anteriorly may erode the cortex and lead to collection of pus below the periosteum leading to a swelling known as Pott's puffy tumor. [1][2][3][4][5][6][7][8][9] The direct spread of infection through the posterior table of frontal sinus may lead to complications such as meningitis, epidural abscess, or subdural abscess.…”

“…3,5 Direct spread of infection from the frontal sinus to the frontal bone anteriorly may erode the cortex and lead to collection of pus below the periosteum leading to a swelling known as Pott's puffy tumor. [1][2][3][4][5][6][7][8][9] The direct spread of infection through the posterior table of frontal sinus may lead to complications such as meningitis, epidural abscess, or subdural abscess. [1][2][3][4][5][6][7][8][9] Another mechanism to potentially spread infection from the sinuses is via the hematogenous route.…”

Complications of Sinusitis, Management with Limited Resources-: A Report of Two Cases with a Review of the Literature

“…Epidural abscesses progress slowly than subdural empymas and are diagnosed early [13,16] hence have better outcomes in management [11,14,16] . -Subdural empyma spreads rapidly and freely within a preformed space so it has a more culminant acute presentation with early neurologic deficits [10,17] .…”

Puffy Frontal Edema: A Serious Life-Threatening Finding of Pott’s Puffy Tumor: Case Report

“…1 Currently, it is defined as a forehead-localized swelling with overlying subperiosteal abscess and osteomyelitis of the frontal bone. [2][3][4][5] In this case report we presented a 13-year old male patient with Pott's puffy tumour to emphasize the importance of early diagnosis and early initiation of therapy in the development of morbidity and mortality.…”