Pott's puffy tumour: an unusual presentation and management.

Pott's puffy tumour is a rare clinical entity in this era of antibiotics. It is usually seen as a complication of frontal sinusitis. This is the first report of Pott's puffy tumour presenting as a complication of maxillary sinusitis. This is also the first reported case of Pott's puffy tumour treated with debridement and gentamicin beads. We discuss the clinical presentation and successful treatment of this rare disease.     

Cervical Pott's disease revealed by retropharyngeal abscesses

INTRODUCTION: Retropharyngeal abscesses are exceptional in adults. The etiologies are numerous, cervical spine tuberculosis is one of them. OBSERVATION: We report two cases of cervical Pott's disease revealed by a retropharyngeal abscess. The clinical presentation was non-specific, dominated by oropharyngeal obstruction. Radiological findings suggested the diagnosis, showing a retropharyngeal collection with vertebral osteolysis. The bacteriological and histological assessment confirmed the diagnosis. The evolution was favorable after treatment by antituberculosis drugs. DISCUSSION: Vertebral tuberculosis is rare. Cervical involvement is exceptional, and retropharyngeal abscesses can be the revealing feature of this condition. Symptoms are not specific. The diagnosis is based on radiological and bacteriological assessment. Treatment with antituberculosis drugs leads to a good outcome.     

Asymptomatic retropharyngeal abscess related to cervical Pott's disease

Pott's disease is an uncommon manifestation of tuberculosis, which usually involves thoracic or lumbar vertebrae. The body of the vertebrae is most severely affected and a compression fracture is an almost inevitable consequence of the disease. A paravertabral abscess generally accompanies vertebral involvement. Tenderness over the involved vertebrae, weakness of the related muscles, and paraesthesia are the usual symptoms. In this article, we report a case of cervical Pott's disease presenting mainly with neurologic symptoms such as weakness, pain, numbness of both arms and hands, and an asymptomatic retropharyngeal abscess.     

Pott's puffy tumor treated by endoscopic frontal sinusotomy

Pott's puffy tumor is a serious extracranial complication of frontal sinusitis. The formation of this entity is facilitated by the close anatomic relationship between the paranasal sinuses and the frontal bone. Furthermore, the rich diploic venous drainage of the region enhances the spread of the infection. We report on successful functional endoscopic frontal sinusotomy in a series of four cases of Pott's puffy tumor following acute frontal sinusitis, between the years 1994 and 1997. We emphasize the advantages of this approach over the external approaches as follows: the technique treats the causative source of the disease, the morbidity is low, and it avoids facial cosmetic trauma and sequela.     

Endoscopic Endonasal Treatment of a Pott's Puffy Tumor

Pott's puffy tumor is an infrequent entity characterized by a subperiosteal abscess associated with frontal bone osteomyelitis. It has become rare due to the development of antibiotics and is usually seen as a complication of frontal sinusitis. Although Pott's puffy tumor is more commonly described in children, it should also be included in the differential diagnosis of swelling on the forehead in adults. Once the diagnosis is suspected, appropriate imaging should be performed to evaluate the possible complications. The treatment of Pott's puffy tumor combines medical and surgical approaches in order to prevent further complications. The goal of surgery is to drain the sinus and to excise the infected bone if necessary. The endoscopic endonasal approach is a safe and effective alternative to the external approach. This report describes the case of a 25-year-old man with Pott's puffy tumor resulting from frontal sinusitis.     

Pott's puffy tumor

Between the complications of frontal sinusitis orbital or intracranial are the most frequent encountered (meningitis, abscesses and empyemas). All are secondary to thrombophlebitis of veins communicating the intracranial cavity with the frontal sinus. Frontal osteomyelitis secondary to sinusitis, the so-called Pott's puffy tumor, is a much more rare aftermath in the antibiotic epoch. Pott's puffy tumor must be suspected in patients with frontal headache followed by frontal oedema. Concerning the diagnosis clinical suspicion is essential and must be settled throughout computerized tomography and/or magnetic resonance or even bone scintiscan. The paper report 2 cases, one an orbital periostitis, at the beginning of the disease, which was recovered with medical antibiotic treatment and another one, an osteomyelitis somewhat evolved requiring surgery through frontal osteoplasty. Perusal of etiology, pathogenesis, diagnosis and treatment of this complication.     

Pott's puffy tumour in a pre-adolescent child: the youngest reported in the post-antibiotic era

Pott's puffy tumour is a subperisosteal abscess associated with a cranial osteomyelitis. A rare consequence of trauma or frontal sinusitis, it is often an indicator of intracranial complications. At 3 years of age, the patient described is the youngest reported with this condition. The occurrence of such pathology in pre-adolescent children is very rare and this case is one of three reported in the English literature in the post-antibiotic era.     

Pott's puffy tumour caused by mucormycosis

A case of Pott's puffy tumour in a diabetic patient with renal failure is reported. The patient did not respond to intravenous antibiotics and further investigation revealed that the patient had mucormycosis. As far as we are aware, this is the first case of Pott's puffy tumour due to mucormycosis to be reported in the literature.     

Latent mastoiditis: no room for complacency

The administration of antibiotics in otitis media alters the natural course of the disease process. If the antibiotics used are inappropriate, or if dosage or duration of treatment is inadequate, an imminent intracranial complication may be masked. A case of latent mastoiditis presenting with Pott's puffy tumour is described.     

Clinical and radiological aspects of maxillo-nasal dysostosis: "naso-maxillo-vertebral syndrome". A study of 34 new cases (author's transl)]

Maxillo-nasal dysostosis is not uncommon as we have noted 34 new cases in eight years. The most characteristic anomalies, well described by Binder, are nasal hypoplasia both of bone and cartilage with agenesis of the nasal spine, as well as a characteristic rearrangement of the naso-labial muscles. On first seeing the patient the disease is generally recognized by the very typical aspect of the nose. There very often exists however other dental, mandibular and cervical spine anomolies. It is indispensable to look for these anomalies in the work up of patients with this malformation syndrome "the naso-maxillo-vertebral syndrome", in order to better understand the disease and better treat the patients.     

Endoscopic sinus surgery for mucoceles: a viable alternative

Functional endoscopic surgery affords the potential for dramatically reducing operative morbidity of surgery for paranasal sinus mucoceles by offering a minimally invasive approach under local anesthesia. Following surgery, direct endoscopic visualization of the area enables accurate follow-up. Unlike sinus obliteration, the ability to accurately image the sinus by CT is also preserved. This paper presents our preliminary experience with 18 mucoceles in which endoscopic sinus surgery was attempted. Five patients had preoperative proptosis and diplopia, three had Pott's puffy tumor and five had erosion of the posterior table of the frontal sinus. Fifteen patients were satisfactorily treated endoscopically, two lesions could not be satisfactorily approached and required external surgery, and one patient had persistent disease. No disease recurrence has been noted to date with endoscopic follow-up of up to 42 months.     

Intracranial complications of acute frontal sinusitis

Despite advances in the diagnosis and treatment of acute frontal sinusitis, there is still significant occurrence of intracranial complications. Urgent surgical evacuation of any intracranial collection is required; however, the surgical management of the associated sinusitis remains controversial. Ten patients presented to this department over a 12-month period with subdural empyema secondary to acute frontal sinusitis. Four patients had a coexisting Pott's puffy tumour and one patient had a periorbital abscess. Each patient was managed using a multidisciplinary approach. A frontal sinus trephine/drain +/- antral washout was performed at the same time as craniotomy with evacuation of the empyema. With this approach only two patients suffered long-term morbidity in our series, in the form of persistent neurological or cognitive deficit. No patient required a definitive sinus procedure. This study emphasizes the need for the early assessment and intervention of patients with an intracranial complication secondary to acute frontal sinusitis. Further assessment of the underlying sinus disease is indicated during outpatient follow up after the acute episode.     

Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia. A case report

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory stiffening disease of the vertebral spine due to extensive bone formation, often causing complete bridging of neighbouring intervertebral spaces. Except for the spine, other parts of the skeleton are rarely affected. Although in 78% of all cases the cervical spine is involved, dysphagia is rare (17%), being caused either by mechanical obstruction or by para-oesophageal inflammation due to irritation at the osteophyte processes. The diagnosis may be established by conventional X-ray of the spine, oesophagogram or CT. The paper describes a patient presenting with dysphagia caused by spondylophyte blockage of the cervical spine.     

An 8-year-old boy with a Pott's puffy tumor

An 8-year old boy with a history of trauma, sinusitis and a swelling of the frontal bone with somnolence was diagnosed with a Pott's puffy tumor (PPT). Minimal invasive surgical intervention was performed together with a strict regimen of antibiotic therapy. In this case debridement of the frontal bone was not necessary. Serial X-ray imaging of the skull showed complete ossification of the frontal bone lesion. Early diagnosis using thorough radiological evaluation is necessary to effectuate the proper therapeutic approach. For this reason, a patient with a forehead swelling and a history of trauma and/or sinusitis should be suspected for a PPT.     

A case of Pott's tumor in a 13-year-old boy

Pott's puffy tumor is an infrequent entity characterized by subperiosteal abscess associated with frontal bone osteomyelitis. It is usually seen as a complication of frontal sinusitis. Although cases, in patients of all ages have been reported, teenagers are the most frequently affected. Despite modern methods of diagnosis and treatment, 9 new cases in children, have been published in the last 7 years. This paper describes the case of 13-year-old boy with subperiosteal abscess resulting from exacerbation of chronic frontal sinusitis. Complete resolution occurred with an intensive antibiotic regime and drainage of frontal sinus and subperiosteal abscess.     

Intracranial complications of frontal sinusitis. A report of two cases

Two cases are reported of intracranial complications of sinusitis, unusual nowadays. They were caused by osteomyelitis of the frontal bone following chronic frontal sinusitis. These cases were distinguished by complete destruction of the posterior wall of the sinus involved: in one of the cases there was an acute central neurological disturbance caused by a cerebral abscess; in the other patient, who came for consultation because of a Pott's Puffy tumour, a sizeable epidural abscess was found.     

Use of the 70-degree diamond burr in the management of complicated frontal sinus disease

OBJECTIVES/HYPOTHESIS: Management of frontal sinus disease may require drill-out of bone in the frontal recess for access, ventilation, and drainage of the sinus cavity; removal of osteitic foci; or resection of neoplastic tissue. Technological advances, particularly burrs with angles of 70 degrees and stereotactic navigational imaging, offer new opportunities to provide access and minimize trauma. The preliminary study evaluates the safety and efficacy of such minimally invasive approaches. STUDY DESIGN: Retrospective review. METHODS: The authors describe the use of a 70-degree diamond burr in a series of 10 patients with complicated frontal sinus disease who underwent endoscopic frontal sinusotomy under stereotactic imaging guidance. RESULTS: The diagnoses consisted of frontal sinus mucocele (n = 4), chronic frontal sinusitis (n = 1), Pott's puffy tumor after frontoethmoid fracture (n = 1), and recurrent inverting papilloma (n = 4). Partial septectomy was required in 6 of 10 patients. No complications were attributable to the drill-out procedure, despite a pre-existing frontoethmoid bony dehiscence in 6 of 10 patients. One patient had a CSF leak during removal of tumor from the skull base. One patient required revision frontal sinusotomy 10 months after the initial procedure, and another required further surgery for residual inverting papilloma on the medial orbital wall. All frontal sinusotomies were patent at last follow-up (mean period, 9.3 mo). CONCLUSION: Extended endoscopic frontal sinusotomy may be necessary in the management of complicated frontal sinus inflammatory disease and inverting papilloma. The 70-degree diamond burr is a safe and effective tool for access to the frontal recess. Complication rates appear to be similar to those for other extended frontal sinusotomy approaches.     

Intracranial complications of sinusitis: a 15-year review of 39 cases

Despite improvements in antibiotic therapies and surgical techniques, sinusitis still carries a risk of serious and potentially fatal complications. We examined the charts of 82 patients who had been admitted to the University of Mississippi Medical Center between Jan. 1, 1985, and Dec. 31, 1999, for treatment of complications of sinusitis. Of these 82 patients, 43 had orbital complications and 39 had intracranial complications. In this article, we describe our findings in those patients who had intracranial complications (our findings in patients with orbital complications will be reported in a future article). The most common intracranial complication was meningitis; others were epidural abscess, subdural abscess, intracerebral abscess, Pott's puffy tumor, and superior sagittal sinus thrombosis. Most patients with meningitis were treated with drug therapy only; patients with abscesses were generally treated with intravenous antibiotics and drainage of the affected sinus and the abscess. Advancements in antibiotic therapy, endoscopic surgery, imaging studies, and computer-assisted surgery have helped improve outcomes. Management of these patients should be undertaken immediately and is best achieved via a multidisciplinary approach, involving the otolaryngologist, neurosurgeon, radiologist, anesthesiologist, infection disease specialist, pediatrician, internist, and others.     

Osteochondrosis of the cervical spine as a cause of globus sensation and dysphagia

Dysphagia and globus hystericus can be caused by disorders of the cervical spine. Functional disorders of the upper cervical spine are the most common cause of dysphagia and globus hystericus due to vertebral disease. Prominent osteophytes of the ventral spine occasionally cause these complaints. In these cases the operative ablation of the osteophytes is effective. This is demonstrated in the following report, and the indication for operation is discussed.