Pott´s puffy tumor treatment guidelines. Lliterature review
Abstract Introduction and objective: The aim of this study was to provide an updated review of medical and surgical treatment in patients with subperiosteal abscesses, secondary to osteomyelitis of the frontal bone. Method: The search was made in PubMed, BVS (virtual health library Spain) and Scopus of the different therapeutic options about Pott's puffy tumor. The review was carried out following the PRISMA criteria. Results: Twenty articles were selected in the bibliographic review. 30 patients (24 males, with a mean age of 27 years) were reviewed.The main cause was chronic rhinosinusitis (90%), followed by local trauma. In most cases Draf 2 endoscopic drainage was performed (60%), 5 patients had Draf 3 procedure , three Draf 1 procedure and only one, Draf 2B procedure. One patient was treated by balloon sinuplasty and another by isolated external craniotomy. All patients had either oral or intravenous antibiotics of varying duration. although the therapeutic scheme of vancomycin + ceftriaxoneIV predominates for 6 weeks. There were no further complications following endoscopic surgery. Fistulas healed without requiring surgical debridement or closure.?Discussion: Pott's puffy tumor is a very rare pathology. Due to the rarity of the pathology, many cases have been underdiagnosed leading to intracranial complications. The external approach has been the treatment for years; it is currently advocated an endonasal approach sometimes guided by neuronavigator; in addition to the corresponding antibiotic therapy for long time. Conclusions: Some Pott´s puffy tumor cases can be managed endoscopically. The availability of powered angled instruments, high-definition video, and image guidance systems have provided the otolaryngologists with a credible alternative to traditional techniques. Furthermore, improved bioavailability of antibiotics may obviate the need for craniotomy and external drains.
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1 Akkiyama K, Karaki M, Mori N. Evaluation of adult Pott´s puffy tumor: our five cases and 27 literature Cases. Laryngoscope.2012; 122: 2382-2388.
2 Leong S, Phil M. Minimally invasive surgery for Pott´s Puffy tumor: is it time for a paradigm shift in managing a 250- year-old problem? Ann Otol Rhinol Laryngol.2017;126(6):433-437.
3 Van der Poel N, Hansen, F, Georgalas, C, Fokkens, W. Minimally invasive treatment of patients with Pott’s puffy tumour with or without endocranial extension a case series of six patients: Our Experience. Clin Otolaryngol.2016 Oct;41(5):596-601.
4 Ball SL, Carrie S. Pott’s puffy tumour: a forgotten diagnosis. BMJ Case Rep.2015;136(1):1-5.
5 Pérez C, Avilés M. Cefalea y edema fronto-orbitario de aparición súbita en un adolescente. Enferm Infecc Microbiol Clin.2017;35(6):386–387
6 Corcóstegui T, Guío L, Aurrekoetxea J, Montejo J. Tumoración frontal recidivante en paciente con craneotomías de repetición. Infecc Microbiol Clin.2015;35(4):262-263.
7 Koltsidopoulos P, Papageorgiou E, Skoulakis C. Acute sinusitis complicated with Pott puffy tomour. CMAJ.2019; 191(6): E165.
8 Rumi S, Kazuhiro O, Katsuhiro I, Yasuhiro T. Recurrent Pott’s Puffy Tumor treated with anterior skull base resection with reconstruction of the anterolateral thigh flap. Craniofac Surg.2019;30(1):94-96.
9 Olmaz B, Cingoz M, Akdogan E, Kandemirli SG. Correlation of imaging and intraoperative findings in Pott's puffytumour. Scott Med J.2019;64(1):25-29.
10 Simonin A , Passaplan C, Rusconi A, Colin A, Véronique Erard V, Stauffer E, et al. Pott’s puffy tumor presenting as a frontal swelling under a Swiss army helmet. Clin Neurol Neurosurg. 2018;173:115-117
11 Morris MS, Wilkins SE. Pott Puffy Tumor. J Am Osteopath Assoc. 2018;118(1):55.
12 Cannon L, Zwemer E, Stephens JR. Puff laddy: a 5-year-old boy with forehead swelling. BMJ Case Rep.2017.doi:10.1136/bcr-2017-223340.
13 Allfather P, Joshua N. Image in emergency medicine.Ann Emerg Med.2017;70:771.
14 Nastovska R, Lim LL.Sinusitis complicated by frontal bone osteomyelitis in a youngpatient. Med J Aust.2017;207(9):376.
15 Geyton T, Henderson A, Morris J, McDonald S. A case of Pott’s puffy tumour from primary dental infection. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222294.
16 Simsek H. Patient presenting with frontal subperiosteal abscess and headache: a case of Pott’s puffy tumour. Brit J Neurosurg.2017;33(3):275-277.
17 Pasin F, Bonardi S, Modoni A. When the diagnosis is written on the forehead. Eur J Intern Med. 2018;47:e1-e2
18 Brown T, Campbell A, Blyth C, Bowen A. Pott’s puffy tumour. J. Paediatr.2017;53:197-199.
19 Ganapathy P, Chundury R, Perry JD. Pott's Puffy Tumor: A Rare Presentation. Ophthalmic Plast Reconstr Surg.2017;33(5):e132.
20 Apostolakos D, Tang I. Image Diagnosis: Pott Puffy tumor. Perm J.2016; 20(3): 15-157.
21 Palabiyik F, Yazici Z, Benhur Cetin, Celebi S, MD, Hacimustafaoglu M. Pott Puffy Tumor in Children: A Rare Emergency Clinical Entity. J Craniofac Surg.2016;27(3):313-316
22 Miller B. 65-year-old man with forehead swelling. Cleve Clin JMed.2016;83(2):95-96.
23 Liberati A, Altman DG, Tetzla J, Mulrow C, Gotzsche PC, Loannidis JP. PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol.2009;62:e1–34.
24 Mohammed K, Goldberg A .Unilateral transnasal endoscopic approach to frontal sinuses: Draf IIc. Allergy Rhinol.2013;4(2):82-87.
25 Tatsumi S, Ri M, Higashi N, Wakayama N, Matsune S, Tosa M. Pott´s puffy Tumor in an adult: A case report and Review of literatura. J Nippon Med.2016; 83(5): 211-214
26 Sullivan, Poetker D (2013) Anterior table remodeling after treatment for Pott’s puffy tumor. Am J Otolaryngol.2013; 34:265–267
2 Leong S, Phil M. Minimally invasive surgery for Pott´s Puffy tumor: is it time for a paradigm shift in managing a 250- year-old problem? Ann Otol Rhinol Laryngol.2017;126(6):433-437.
3 Van der Poel N, Hansen, F, Georgalas, C, Fokkens, W. Minimally invasive treatment of patients with Pott’s puffy tumour with or without endocranial extension a case series of six patients: Our Experience. Clin Otolaryngol.2016 Oct;41(5):596-601.
4 Ball SL, Carrie S. Pott’s puffy tumour: a forgotten diagnosis. BMJ Case Rep.2015;136(1):1-5.
5 Pérez C, Avilés M. Cefalea y edema fronto-orbitario de aparición súbita en un adolescente. Enferm Infecc Microbiol Clin.2017;35(6):386–387
6 Corcóstegui T, Guío L, Aurrekoetxea J, Montejo J. Tumoración frontal recidivante en paciente con craneotomías de repetición. Infecc Microbiol Clin.2015;35(4):262-263.
7 Koltsidopoulos P, Papageorgiou E, Skoulakis C. Acute sinusitis complicated with Pott puffy tomour. CMAJ.2019; 191(6): E165.
8 Rumi S, Kazuhiro O, Katsuhiro I, Yasuhiro T. Recurrent Pott’s Puffy Tumor treated with anterior skull base resection with reconstruction of the anterolateral thigh flap. Craniofac Surg.2019;30(1):94-96.
9 Olmaz B, Cingoz M, Akdogan E, Kandemirli SG. Correlation of imaging and intraoperative findings in Pott's puffytumour. Scott Med J.2019;64(1):25-29.
10 Simonin A , Passaplan C, Rusconi A, Colin A, Véronique Erard V, Stauffer E, et al. Pott’s puffy tumor presenting as a frontal swelling under a Swiss army helmet. Clin Neurol Neurosurg. 2018;173:115-117
11 Morris MS, Wilkins SE. Pott Puffy Tumor. J Am Osteopath Assoc. 2018;118(1):55.
12 Cannon L, Zwemer E, Stephens JR. Puff laddy: a 5-year-old boy with forehead swelling. BMJ Case Rep.2017.doi:10.1136/bcr-2017-223340.
13 Allfather P, Joshua N. Image in emergency medicine.Ann Emerg Med.2017;70:771.
14 Nastovska R, Lim LL.Sinusitis complicated by frontal bone osteomyelitis in a youngpatient. Med J Aust.2017;207(9):376.
15 Geyton T, Henderson A, Morris J, McDonald S. A case of Pott’s puffy tumour from primary dental infection. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222294.
16 Simsek H. Patient presenting with frontal subperiosteal abscess and headache: a case of Pott’s puffy tumour. Brit J Neurosurg.2017;33(3):275-277.
17 Pasin F, Bonardi S, Modoni A. When the diagnosis is written on the forehead. Eur J Intern Med. 2018;47:e1-e2
18 Brown T, Campbell A, Blyth C, Bowen A. Pott’s puffy tumour. J. Paediatr.2017;53:197-199.
19 Ganapathy P, Chundury R, Perry JD. Pott's Puffy Tumor: A Rare Presentation. Ophthalmic Plast Reconstr Surg.2017;33(5):e132.
20 Apostolakos D, Tang I. Image Diagnosis: Pott Puffy tumor. Perm J.2016; 20(3): 15-157.
21 Palabiyik F, Yazici Z, Benhur Cetin, Celebi S, MD, Hacimustafaoglu M. Pott Puffy Tumor in Children: A Rare Emergency Clinical Entity. J Craniofac Surg.2016;27(3):313-316
22 Miller B. 65-year-old man with forehead swelling. Cleve Clin JMed.2016;83(2):95-96.
23 Liberati A, Altman DG, Tetzla J, Mulrow C, Gotzsche PC, Loannidis JP. PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol.2009;62:e1–34.
24 Mohammed K, Goldberg A .Unilateral transnasal endoscopic approach to frontal sinuses: Draf IIc. Allergy Rhinol.2013;4(2):82-87.
25 Tatsumi S, Ri M, Higashi N, Wakayama N, Matsune S, Tosa M. Pott´s puffy Tumor in an adult: A case report and Review of literatura. J Nippon Med.2016; 83(5): 211-214
26 Sullivan, Poetker D (2013) Anterior table remodeling after treatment for Pott’s puffy tumor. Am J Otolaryngol.2013; 34:265–267
Salom-Coveñas, C., Benito-Navarro, J. R., Gutiérrez-Gallardo, A., & Porras-Alonso, E. (2020). Pott´s puffy tumor treatment guidelines. Lliterature review. Revista ORL, 11(4), 449–456. https://doi.org/10.14201/orl.23104
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