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.

Keywords:
Epidural abscess, Intracranial abscess, Percivall Pott, Puffy tumor, Sinusitis, Subdural empyema
1.
Potts P: Observations on the Nature and Consequences of Wounds and Contusions of the Head, etc. London, 1760, pp 38–58.
2.
Ravitch MM: Surgery in 1776. Ann Surg 1977;186:291–300.
3.
Brook I, Friedman EM, Rodriguez WJ, Controni G: Complications of sinusitis in children. Pediatrics 1980;66:568–572.
4.
Courville CB, Rosenwald LK: Intracranial complications of infection of nasal cavities and accessory sinuses. Arch Otolaryngol 1938;27:692–731.
5.
Feder HM Jr, Cates KL, Cementina AM: Pott’s puffy tumor: A serious occult infection. Pediatrics 1987;79:625–629.
6.
Babu RP, Todor R, Kasoff SS: Pott’s puffy tumor: The forgotten entity. J Neurosurg 1996;84:110–112.
7.
Thomas JN, Nel JR: Acute spreading osteomyelitis of the skull complicating frontal sinusitis. J Laryngol Otol 1977;91:55–62.
8.
Mammen-Prasad E, Murillo JL, Titelbaum JA: Infectious disease rounds: Pott’s puffy tumor with intracranial complications. N J Med 1992;89:S37–S39.
9.
Remmler D, Boles R: Intracranial complications of frontal sinusitis. Laryngoscope 1980;90:1814–1824.
10.
Tudor RB, Carson JP, Pulliam MV, Hill A: Pott’s puffy tumor, frontal sinusitis, frontal bone osteomyelitis and epidural abscess secondary to a wrestling injury. Am J Sports Med 1981;9:390–392.
11.
Wenig BL, Goldstein MN, Abramson AL: Frontal sinusitis and its intracranial complications. Int J Pediatr Otorhinolaryngol 1983;5:285–302.
12.
Hore I, Mitchell RB, Radcliffe G, De Casso Moxo C: Pott’s puffy tumor: A rare cause of forehead swelling in a child. Int J Clin Pract 2000;54:267–268.
13.
Clark JR, Lim JK, Poole M: Pott’s puffy tumor: A clinical variant. Aust NZ J Surg 1999;69:759–762.
14.
Uren RF, Howman-Giles R: Pott’s puffy tumor. Scintigraphic findings. Clin Nucl Med 1992;17:724–727.
15.
Holder J, Corbin D, Marquez S, Clarke H, Walcott J, Thomas R: Pott’s puffy tumor and subdural empyema following frontal sinusitis. West Indian Med J 1991;40:33–36.
16.
Pender ES: Pott’s puffy tumor: A complication of frontal sinusitis. Pediatr Emerg Care 1990;6:280–284.
17.
Procino ND: Pott’s puffy tumor in a seven-year-old boy. Ear Nose Throat J 1978;57:516–519.
18.
Fairbanks DN, Milmoe GJ: The diagnosis and management of sinusitis in children. Complications and sequelae: An otolaryngologist’s perspective. Pediatr Infect Dis 1985;4(suppl 6):S75–S79.
19.
Bluestone CD, Kenna MA, Stool SE: Pediatric Otolaryngology, ed 3. Philadelphia, Saunders, 1996.
20.
Davis W: Development and Anatomy of the Nasal Accessory Sinuses in Man. Philadelphia, Saunders, 1914.
21.
Onodi A: Accessory Sinuses of the Nose in Children. New York, William Wood, 1911.
22.
Farmer TW, Wise GR: Subdural empyema in infants, children, and adults. Neurology 1973;23:254–261.
23.
Catlin FI, Cluff LE, Reynolds RC: The bacteriology of acute and chronic sinusitis. South Med J 1965;58:1497.
24.
Palva T, Gronros JA, Plava A: Bacteriology and pathology of chronic maxillary sinusitis. Acta Otolaryngol 1962;54:159.
25.
Sable NS, Hengerer A, Powel KR: Acute frontal sinusitis with intracranial complications. Pediatr Infect Dis 1984;84:58–61.
26.
Young LW: Radiologic imaging of Pott’s puffy tumor and other frontal sinusitis complications. Am J Dis Child 1986;140:197.
27.
Wald ER: Epidemiology, pathophysiology, and etiology of sinusitis. Pediatr Infect Dis J 1985;4(suppl 6):S51–S53.
© 2001 S. Karger AG, Basel
2001
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.