Abstract
Introduction
Pott’s puffy tumor is characterized by subperiosteal abscess associated with osteomyelitis of frontal bone. Reports are limited for this rare entity in the antibiotics era but increase during past decade.
Methods
We had clinical analysis of a series with six consecutive pediatric patients of Pott’s puffy tumor during 20 years in a tertiary medical center via retrospective chart review. One case was described in detail.
Results
Male-to-female ratio was 5:1. The mean age at the time of diagnosis was 13 years–3 months. The risk factors were acute sinusitis in two (33%), chronic sinusitis in two (33%), recent head trauma in two (33%), and acupuncture therapy on skull in one (17%). The commonest presenting symptoms were fever, headache, forehead tenderness, vomiting, and fatigue/malaise (100%). Pott’s puffy tumor was diagnosed on average the seventh day after fever, and half had intracranial involvement at diagnosis. All had intracranial infections, and most of them had subdural empyema. The most often involved sinus was frontal sinus (100%). The frontal lobe was the most common site of intracranial infection (100%), two thirds of which are polymicrobial from two or more sites. The initial operation was performed on average on the 5.8th days after diagnosis. Half of the patients underwent reoperation. The mortality rate was 17% (one of six).
Conclusion
The symptoms of Pott’s puffy tumor are inconspicuous even though early intracranial involvement often occurred. The importance of early diagnosis and aggravated and prompt treatment with prolonged antibiotic therapy is emphasized for better outcome.
Similar content being viewed by others
References
Bambakidis NC, Cohen AR (2001) Intracranial complications of frontal sinusitis in children: Pott’s puffy tumor revisited. Pediatr Neurosurg 35:82–89
Forgie SE, Marrie TJ (2008) Pott’s puffy tumor. Am J Med 121:1041–1042
Kombogiorgas D, Solanki GA (2006) The Pott puffy tumor revisited: neurosurgical implications of this unforgotten entity. Case report and review of the literature. J Neurosurg 105:143–149
Tattersall R (2002) Pott’s puffy tumour. Lancet 359:1060–1063
Bannon PD, McCormack RF (2008) Pott’s puffy tumor and epidural abscess arising from pansinusitis. J Emerg Med. doi:10.1016/j.jemermed.2008.04.050
Wu CT, Huang JL, Hsia SH, Lee HY, Lin JJ (2008) Pott’s puffy tumor after acupuncture therapy. Eur J Pediatr 168:1147–1149
Karaman E, Hacizade Y, Isildak H, Kaytaz A (2008) Pott’s puffy tumor. J Craniofac Surg 19:1694–1697
Rao M, Steele RW, Ward KJ (2003) A “hickey”. Epidural brain abscess, osteomyelitis of the frontal bone, and subcutaneous abscess (Pott puffy tumor). Clin Pediatr (Phila) 42:657–660
Quraishi H, Zevallos JP (2006) Subdural empyema as a complication of sinusitis in the pediatric population. Int J Pediatr Otorhinolaryngol 70:1581–1586
Brook I (2009) Microbiology and antimicrobial treatment of orbital and intracranial complications of sinusitis in children and their management. Int J Pediatr Otorhinolaryngol 73:1183–1186
Herrmann BW, Forsen JW Jr (2004) Simultaneous intracranial and orbital complications of acute rhinosinusitis in children. Int J Pediatr Otorhinolaryngol 68:619–625
Kombogiorgas D, Seth R, Athwal R, Modha J, Singh J (2007) Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg 21:603–609
Adame N, Hedlund G, Byington CL (2005) Sinogenic intracranial empyema in children. Pediatrics 116:e461–e467
Martinez-Diaz GJ, Hsia R (2008) Pott’s Puffy tumor after minor head trauma. Am J Emerg Med 26(739):e731–e733
Raja V, Low C, Sastry A, Moriarty B (2007) Pott’s puffy tumor following an insect bite. J Postgrad Med 53:114–116
Tudor RB, Carson JP, Pulliam MW, Hill A (1981) Pott’s puffy tumor, frontal sinusitis, frontal bone osteomyelitis, and epidural abscess secondary to a wrestling injury. Am J Sports Med 9:390–391
Gupta M, El-Hakim H, Bhargava R, Mehta V (2004) Pott’s puffy tumour in a pre-adolescent child: the youngest reported in the post-antibiotic era. Int J Pediatr Otorhinolaryngol 68:373–378
Ibarra S, Aguirrebengoa K, Pomposo I, Bereciartua E, Montejo M, Gonzalez de Zarate P (1999) Osteomyelitis of the frontal bone (Pott’s puffy tumor). A report of 5 patients. Enferm Infecc Microbiol Clin 17:489–492
Durur-Subasi I, Kantarci M, Karakaya A, Orbak Z, Ogul H, Alp H (2008) Pott’s puffy tumor: multidetector computed tomography findings. J Craniofac Surg 19:1697–1699
Yucel OT, Ogretmenoglu O (1998) Subdural empyema and blindness due to cavernous sinus thrombosis in acute frontal sinusitis. Int J Pediatr Otorhinolaryngol 46:121–125
Davidson L, McComb JG (2006) Epidural-cutaneous fistula in association with the Pott puffy tumor in an adolescent. Case report. J Neurosurg 105:235–237
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsai, BY., Lin, KL., Lin, TY. et al. Pott’s puffy tumor in children. Childs Nerv Syst 26, 53–60 (2010). https://doi.org/10.1007/s00381-009-0954-z
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-009-0954-z