Pott's Puffy Tumor
This page was last updated on: October 11, 2020

Named after Sir Percival Pott (1713-1788), an English surgeon who first described it in 1760, Pott's puffy tumor is a serious complication of bacterial frontal sinusitis.

It consists of a subperiosteal abscess and osteomyelitis of the frontal bone.  Patients present with a tender doughy soft tissue swelling that causes pitting edema over the frontal bone. Intracranial complications such as epidural abscess, subdural empyema, meningitis, cerebral abscess, and dural-vein thrombophlebitis may also occur.

Treatment consists of surgical drainage of the abscess and the frontal sinus and 6 weeks of intravenous antibiotic therapy directed at the isolated organisms.  Traditionally, surgical treatment of Pott's puffy umor required an external approach called trephination.

Trephination is carried out  in the floor of the sinus.  A drain placed through the trephine allows the drainage of sinus contents and can be used to irrigate with antibiotic solutions.

With increased experience and improved technique, the success rate of endoscopic sinus surgeryhave surpassed those of the external approach.

The general rule of frontal sinus surgery is to chose the least invasive procedure with which the surgeon is comfortable and whish will accomplish the task.

Jinho Jung, Hak Chun Lee et al.  Endoscopic Endonasal Treatment of Pott's Puffy Tumor.  Clin Exp Otorhinolaryngol  212 Jun, 5 (2)

Sagittal and axial MRI cuts show fluid in the frontal sinus communicating with the subperiosteal abscess through a defect in the anterior table of the sinus
Trephination of the frontal sinus.
Axial CT scan showing a defect in the anterior table of the frontal sinus
Otolaryngology Houston

Bechara Y. Ghorayeb, MD
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