A Pott’s Puffy Tumor Associated with Epidural - Cutaneous Fistula and Epidural Abscess: Case Report

Year 2017, Volume: 34 Issue: 3, 284 - 287, 01.05.2017

Aleksandar Perić Milanko Milojević Dražen Ivetić

Abstract

Background: Pott’s puffy tumour is characterized by a fluctuate swelling of the frontal region as a result of osteomyelitis of the frontal bone. This inflammatory lesion may propagate endocranially, resulting in acute meningitis, epidural abscess, subdural empyema, cavernous sinus trombophlebitis, cerebritis, and frontal lobe abscess of the brain. Case Report: We present an unusual case of a 33-year-old man suffering from Pott’s puffy tumour whose condition was further complicated by a draining epidural-cutaneous fistula and an epidural abscess. We confirmed the diagnosis by contrast-enhanced computed tomography scanning and magnetic resonance imaging of the head. After intense antibiotic treatment, we performed a combined endoscopic and external surgical approach with drainage of abscesses, evacuation of pus and bone sequestrate and excision of fistulous lesion. The treatment was prolonged with four weeks’ antibiotic administration. Conclusion: Subperiosteal abscess of the frontal bone is an extremely rare complication of frontal sinusitis. This lesion may propagate endocranially, resulting in dangerous intracranial inflammatory lesions. Early diagnosis, medication and surgical therapy are very important in reducing morbidity and mortality.

Keywords

Pott’s puffy tumour, frontal sinusitis, osteomyelitis, antibacterial agents, nasal surgical procedures

References

• 1. Goldberg AN, Oroszlan G, Anderson TD. Complications of frontal sinusitis and their management. Otolaryngol Clin North Am 2001;34:211-25.
• 2. Deutsch E, Hevron I, Eilon A. Pott’s puffy tumor treated by endoscopic frontal sinusotomy. Rhinology 2000;38:177-80.
• 3. Davidson L, McComb JG. Epidural-cutaneous fistula in association with the Pott puffy tumor in an adolescent. Case report. J Neurosurg 2006;105(3 Suppl):235-7
• 4. Ketenci I, Ünlü Y, Tucer B, Vural A. The Pott’s puffy tumor: a dangerous sign for intracranial complications. Eur Arch Otorhinolaryngol 2011;260:1755-63.
• 5. Akiyama K, Karaki M, Mori N. Evaluation of adult Pott’s puffy tumor: our five cases and 27 literature cases. Laryngoscope 2012;122:2382-8.
• 6. Collet S, Grulois V, Eloy P, Rombaux P, Bertrand B. A Pott’s puffy tumour as a late complication of a frontal sinus reconstruction: case report and literature review. Rhinology 2009;47:470-5.
• 7. Orlandi RR. Pott’s puffy tumor. In: Kountakis SE, Senior BA, Draf W, editors. The frontal sinus. Berlin, Heidelberg: Springer; 2005:83-6.
• 8. Trimarchi M, Bertazzoni G, Bussi M. Cocaine induced midline destructive lesions. Rhinology 2014;52:104-11.
• 9. Vanderveken OM, De Smet K, Dogan-Duyar S, Desimpelaere J, Duval ELI, De Praeter M, et al. Pott’s puffy tumour in a 5-year old boy: the role od ultrasound and contrast-enhanced CT imaging; surgical case report. B-ENT 2012;8:127-9.
• 10. Acke F, Lemmerling M, Heylbroeck Ph, De Vos G, Vestraete K. Pott’s puffy tumor: CT and MRI findings. JBR-BRT 2011;94:343-5