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Clinical Images  |   January 2018
Pott Puffy Tumor
Author Notes
  • From Lakeland Health in St Joseph, Michigan (Drs Morris and Wilkins), and the Michigan State University College of Osteopathic Medicine in East Lansing (Dr Morris). Dr Wilkins is a first-year resident. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Michael Morris, DO, 1234 Napier Ave, St Joseph, MI 49085-2112. Email: mmorris1@lakelandhealth.org
     
Article Information
Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   January 2018
Pott Puffy Tumor
The Journal of the American Osteopathic Association, January 2018, Vol. 118, 55. doi:10.7556/jaoa.2018.015
The Journal of the American Osteopathic Association, January 2018, Vol. 118, 55. doi:10.7556/jaoa.2018.015
A 55-year-old woman with recurrent sinusitis and nicotine dependence presented to the family practice clinic with a 1-month history of progressive, soft, well-demarcated swelling of the forehead (image A) associated with frontal headache and nasal congestion. Noncontrast craniofacial computed tomographic scan revealed an abscess eroding through the anterior frontal sinus (image B). Bedside 19-guage needle decompression produced 12 mL of purulent fluid. A loading dose of 3 g empirical ampicillin-sulbactam therapy was delivered intravenously (IV) followed by 1.5 g IV every 6 hours and 2 g of ceftriaxone IV every 24 hours. Although aerobic cultures showed no growth, anaerobic cultures demonstrated gram-negative rods with insufficient growth for identification. Pott puffy tumor (PPT) was diagnosed. Definitive surgical and medical management included an endoscopic left frontal and maxillary sinus operation with balloon sinuplasty, left anterior ethmoidectomy with frontal stent placement, and 875 to 125 mg of amoxicillin-clavulanate taken orally every 12 hours for 7 days after hospital discharge. At 6 weeks, PPT recurred and resolved after repeated endoscopic drainage and ertapenem 1 g IV daily for 6 weeks. 
A subperiosteal abscess of the frontal bone, PPT appears as a localized swelling of the forehead associated with frontal osteomyelitis.1 Risk factors include frontal sinusitis, type 2 diabetes mellitus, craniofacial trauma, and intranasal cocaine administration.1 Common pathogens include Streptococcus and Staphylococcus organisms.1 Pott puffy tumor is associated with a high risk of meningitis, intracranial abscess, and venous sinus thrombosis.2 Successful treatment usually involves surgical debridement followed by 4 to 6 weeks of antimicrobial therapy.1,2 
References
Akiyama K, Karaki M, Mori N. Evaluation of adult Pott's puffy tumor: our five cases and 27 literature cases. Laryngoscope. 2012;122(11): 2382-2388. doi: 10.1002/lary.23490 [CrossRef] [PubMed]
Kombogiorgas D, Solanski GA. The Pott puffy tumor revisited: neurosurgical implications of this unforgotten entity. case report and review of the literature. J Neurosurg. 2006;105(2 suppl):143-149. doi: 10.3171/ped.2006.105.2.143 [PubMed]