Characteristics and therapeutic strategies of Pott's puffy tumor / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the characteristics and therapeutic strategies of Pott's puffy tumor（PPT）. Methods:The clinical data of two patients with PPT were retrospectively analyzed and combined with the literature, focusing on the comprehensive analysis of perioperative diagnosis and treatment strategies. Both patients underwent muti-disciplinary treatment, including timely administration of sufficient antibiotics capable of penetrating the blood-brain barrier. Early removal of PPT lesions was performed using a combined internal and external approach under nasal endoscopic guidance. Results:After standardized perioperative management, the symptoms of the two patients were completely relieved, with no recurrence after one=year follow=up. Postoperative complications such as frontal pain, numbness, local depression, or scar hyperplasiawere not present. Conclusion:PPT, being relatively rare and severe, requires careful attention. Key strategies for standardized perioperative management include multi-disciplinary consultation, timely and adequate antibiotic administration, and surgical intervention using a combined intranasal and extranasal endoscopic approach for lesion removal.

Tumor de Pott y absceso cerebral secundario a sinusitis aguda de foco dentario en paciente pediátrico / Pott's tumor and cerebral abscess secondary to acute sinusitis of dental focus in a pediatric patient

El tumor de Pott es una entidad rara, definida como un absceso subperióstico asociado a osteomielitis del hueso frontal. Suele presentarse como complicación de sinusitis aguda o crónica del seno frontal, y se describe con mayor incidencia en población pediátrica, siendo una complicación grave por su alta morbimortalidad. Se presenta a un paciente pediátrico con tumor de Pott y absceso cerebral posterior a una sinusitis aguda de foco odontogénico, en la que los pilares de tratamiento son drenaje quirúrgico precoz y antibioticoterapia prolongada. Se describe la clínica, manejo médico-quirúrgico y seguimiento posterior, ya que, en ausencia de antecedentes, se debe buscar dirigida- mente enfermedad periodontal y realizar un estudio de inmunodeficiencia primaria.

Pott's tumor is a rare entity, defined as a subperiosteal abscess associated with osteomyelitis of the frontal bone. It usually presents as a complication of acute or chronic sinusitis of the frontal sinus and it is described with a higher incidence in the pediatric population, being a serious complication due to its high morbidity and mortality. We present a pediatric patient with Pott's tumor and brain abscess after acute sinusitis of odontogenic focus, in which the pillars of treatment are an early surgical drainage and prolonged antibiotic therapy. The clinic, medical-surgical management and subsequent follow-up are described, since in the absence of antecedents, periodontal disease should be sought directly and a study of primary immunodeficiency performed.

Tumor Inflamatorio de Pott: reporte de un caso y revisión de la literatura / Pott's puffy tumor: a case report and review of the literature

INTRODUCCIÓN: El Tumor inflamatorio de Pott es una complicación rara de una patología frecuente, como son los cuadros infecciosos sinusales, cada vez más inusual por el uso extendido de antibióticos de amplio espectro, es más frecuente en la población adolescente por la neumatización similar al adulto. Se presenta como un aumento de volumen blando a nivel frontal con una osteomielitis del hueso frontal y un absceso subperióstico. MATERIALES Y MÉTODOS: En este trabajo, se presenta una revisión bibliográfica del tema y un caso de un paciente de 9 años, quien cursó con un cuadro infeccioso sinusal, que posterior desarrollo un aumento de volumen frontal, mostrando las imágenes perioperatorias e intraoperatorias. DISCUSIÓN Y CONCLUSIÓN: El absceso subperióstico secundario a la sinusitis, es una complicación rara. Sin embargo, se debe pensar en el diagnostico en pacientes de evolución tórpida y/o que presentan sintomatología neurológica, como convulsiones, se debe completar el estudio con neuroimagen contrastada.

INTRODUCTION: Pott's inflammatory tumor is a rare complication of a frequent pathology, such as sinus infections, increasingly unusual due to the use of broad-spectrum antibiotics, it is more frequent in the adolescent population due to pneumatization similar to that of adults. It presents as an increase in volume at a frontal level with osteomyelitis of the frontal bone and a subperiosteal abscess. ;MATERIAL AND METHODS: In this work, we present a bibliographic review and a case of a 9-year-old patient, who presented with an infectious sinus, which later developed an increase in frontal volume, the perioperative and intraoperative images are shown. DISCUSSION AND CONCLUSION: Subperiosteal abscess secondary to sinusitis is a rare complication. However, the diagnosis should be considered in patients with torpid evolution and / or who present neurological symptoms, such as seizures, the study must be completed with a contrast brain image.

The Unknown Cause of Pott's Puffy Tumor ­ Importance of Early Diagnose

Pott's puffy tumor (PPT) is characterized by swelling of the glabelar region and osteomyelitis of the frontal bone, owing to a subperiosteal pseudoinflammatory tumor responsible for the detachment of the pericranium from the outer table of the skull. Nowadays, the incidence of PPT is very low, so this entity is frequently underdiagnosed. The late treatment and identification of PPT are strongly associated with intracranial complications, which could jeopardize the life of the patient. In the literature, PPT is described as a complication of frontal head trauma or of chronic sinusitis. There are a few cases reported in patients with frontal insect bites or in recreational nasal drug users, such as cocaine or methamphetamines. In the present case report, the authors describe the case of a 40-year-old male who was submitted to a frontal sebaceous cyst surgery. In the postoperative period, he developed an infectious process compatible with PPT. After an extensive review of the literature, no similar cases were identified. Therefore, in the opinion of the authors, sebaceous cyst surgery should be included in the short list of risk factors for the development of PPT.

Aspects morphologiques inhabituels du mal de pott chez l'adulte

Objectif : décrire les aspects morphologiques atypiques au cours du Mal de Pott.Patients et méthodes : Etude descriptive menée dans le service de Rhumatologie du CHU de Brazzaville du 1er janvier 2013 au 31 juin 2017 (4 ans et 6 mois). Ont été inclus les dossiers des patients âgés de plus de 18 ans, dont le diagnostic de Mal de Pott était retenu, en l'absence de biopsie disco-vertébrale, sur la base des arguments cliniques, paracliniques, thérapeutiques et évolutifs.Les dossiers comportant une radiographie standard du rachis et/ou une imagerie en coupe (TDM/IRM) ont été exploités. Ceux dont l'imagerie ne mettait pas en évidence l'aspect classique de spondylodisciteont été retenus. Les variables d'étude étaient le siège, le nombre de localisation, l'aspect de l'atteinte vertébrale ou discale. Cent dix dossiers ont été retenus.Résultats : Les hommes prédominaient (56,4%) avec un sex ratio de 1,3. L'âge moyen était de 46 ± 16ans (extrêmes : 20-80 ans).La radiographie standard du rachis était réalisée chez tous les patients, la TDM chez 28 patients (25,5%), l'IRM chez 23 patients (20,9%). Les formes atypiques étaient retrouvées dans 34 cas (30,9%), dominées par l'aspect de spondylite (21 cas).Les lésions siégeaient au rachis cervical dans 2 cas, au rachis dorsal dans 9 cas, au rachis lombaire dans 16 cas et au rachis dorsal et lombaire dans 7 cas. L'Atteinte était monofocale dans 2 cas, bifocale dans 20 cas, trifocale dans 9 cas et plus de trois vertèbres dans 3 cas.Conclusion : Les aspects morphologiques inhabituels sont dominés par la spondylite,le plus souvent pluri vertébrale, siégeant surtout au rachis lombaire et/ou dorsal

Complicaciones infecciosas severas del territorio maxilofacial: presentación de casos clínicos / Severe infectious complications of the maxillofacial territory: clinical cases presentation

RESUMEN: Las infecciones en el territorio maxilofacial, son cuadros frecuentes, de origen polimicrobiano, con manifestaciones clínicas muy variables y que están asociadas a múltiples vías de ingreso de los microorganismos al territorio. Un gran porcentaje de estas infecciones se origina en la cavidad oral, principalmente en lesiones bacterianas que sufren los dientes. La compleja anatomía de la cabeza y el cuello, permiten que muchas de estas infecciones se diseminen por espacios profundos, llegando a comprometer órganos o regiones anatómicas adyacentes, que pueden llevar a cuadros clínicos de alto riesgo vital. Los casos clínicos presentados en este artículo corresponden a pacientes tratados en el hospital San Juan de Dios a causa de procesos infecciosos del territorio maxilofacial, por equipos multidisciplinarios.

ABSTRACT: Infections in the maxillofacial territory are frequent cases of polymicrobial origin, with very variable clinical manifestations and are associated with multiple entering pathways of microorganisms in the territory. A large percentage of these infections originate in the oral cavity, mainly in bacterial lesions that undergo experienced by the teeth. The complex anatomy of the head and neck allows many of these infections to spread through deep spaces, leading to compromising adjacent organs or anatomical regions, which can lead to high-risk clinical conditions. The clinical cases presented in this article correspond to patients treated at the San Juan de Dios hospital because of infectious processes of the maxillofacial territory, by multidisciplinary teams.

Tumor inflamatorio de Pott en el siglo XXI: presentación de dos casos / Inflammatory Tumor of Pott in the 21st Century: Presentation of two cases

La sinusitis es una patología frecuente en la edad pediátrica y generalmente se presenta como complicación de una infección de vías respiratorias altas. En la era preantibiotica las sinusitis producían con cierta frecuencia, complicaciones extra o intracraneales. El tumor inflamatorio de Pott es una complicación, actualmente inusual de la sinusitis frontal entre sus causas más frecuentes. Sin embargo, el diagnóstico precoz y el tratamiento médico quirúrgico oportuno son fundamentales para evitar secuelas neurológicas devastadoras o incluso la muerte de los pacientes que padecen esta patología. Se presenta el caso de dos pacientes con diagnóstico de sinusitis, quienes desarrollan el tumor inflamatorio de Pott y sus complicaciones supurativas intracraneales extraaxiales. Se revisa en la literatura, las características clínicas, imagenologicas, diagnóstico y tratamiento de esta entidad.

Tumoración de Pott: A propósito de un caso / Pott puffy tumor: Case report

Se analiza el caso de un niño con sinusitis frontal, con una forma de presentación poco habitual que, además, padecía una complicación intracraneal grave. Las complicaciones intracraneales de las sinusitis son raras en cerebrales y trombosis del seno cavernoso. Se hace hincapié en la importancia del diagnóstico precoz y de un tratamiento empírico inicial adecuado para evitar las posibles complicaciones. Asimismo, cabe enfatizar que una vez producidas estas, requieren un tratamiento médico-quirúrgico intensivo para su resolución.

We present the case of a child with frontal sinusitis, who also suffers from a severe intracranial disease. Although sinusitis intracranial issues are rare nowadays, they include a wide range of serious entities such as meningitis, brain abscesses and thrombosis of the cavernous sinus. We emphasize the importance of early diagnosis and an adequate initial empirical treatment to prevent possible complications. Once they are presented, an aggressive surgical medical treatment is required for its resolution.

A Case of Pott's Puffy Tumor from Recurrent Upper Eyelid Abscess

PURPOSE: To report a case of Pott's puffy tumor from a recurrent upper eyelid abscess. CASE SUMMARY: A 73-year-old male visited our clinic with recurrent upper eyelid abscess over the previous 3 months. The patient did not have any evidence of external injuries, systemic inflammations, or any other specific findings. The best corrected visual acuity was 0.9 in the right and 0.5 in the left eye with normal IOP. Enhanced CT revealed a focal low density mass (11.3 x 12.6 x 10 mm) with peripheral enhancement. An excisional biopsy was performed. Histopathologic examination revealed chronic inflammation and granulation tissue formation and the patient was diagnosed with Pott's puffy tumor. The patient experienced no discomfort after the excision biopsy. At the 14-month follow-up, there were no signs of recurrence. CONCLUSIONS: Although rare, Pott' puffy tumor should be considered in the differential diagnosis of upper eyelid mass.

Endoscopic Endonasal Treatment of a Pott's Puffy Tumor

Pott's puffy tumor is an infrequent entity characterized by a subperiosteal abscess associated with frontal bone osteomyelitis. It has become rare due to the development of antibiotics and is usually seen as a complication of frontal sinusitis. Although Pott's puffy tumor is more commonly described in children, it should also be included in the differential diagnosis of swelling on the forehead in adults. Once the diagnosis is suspected, appropriate imaging should be performed to evaluate the possible complications. The treatment of Pott's puffy tumor combines medical and surgical approaches in order to prevent further complications. The goal of surgery is to drain the sinus and to excise the infected bone if necessary. The endoscopic endonasal approach is a safe and effective alternative to the external approach. This report describes the case of a 25-year-old man with Pott's puffy tumor resulting from frontal sinusitis.

Uso do tensor de difusão na avaliação dos padrões de acometimento da substância branca em pacientes com tumores cerebrais: é uma ferramenta útil para o diagnóstico diferencial? / Use of diffusion tensor magnetic resonance imaging in the assessment of patterns of white matter involvement in patients with brain tumors: is it useful in the differential diagnosis?

OBJETIVO: Propõe-se avaliar o papel do tensor de difusão na avaliação dos diferentes padrões de acometimento da substância branca em pacientes com tumores cerebrais e a utilidade desta técnica no diagnóstico diferencial dessas neoplasias. MATERIAIS E MÉTODOS: Quarenta e quatro pacientes com tumores cerebrais, incluindo gliomas de baixo grau, astrocitomas anaplásicos, glioblastomas multiformes e metástases, foram estudados com imagens de ressonância magnética convencional e tensor de difusão. Os tratos de substância branca próximos aos tumores foram caracterizados como deslocados, interrompidos, infiltrados e edematosos. RESULTADOS: Houve significativa sobreposição entre os padrões de acometimento da substância branca pelo tensor de difusão, uma vez que o padrão deslocado foi observado em todos os tipos de tumor. Os padrões interrompido e infiltrado foram encontrados em glioblastomas multiformes e astrocitomas anaplásicos e o padrão edematoso foi observado em metástases. CONCLUSÃO: Os padrões de envolvimento dos tratos de substância branca cerebral avaliados pelo tensor de difusão auxiliam no mapeamento dos tratos adjacentes aos tumores e fornecem informações importantes sobre a extensão do tumor, no entanto, eles não possibilitam fazer a distinção entre gliomas de baixo e alto graus e metástases.

OBJECTIVE: The present study was aimed at evaluating the role of diffusion tensor imaging for the assessment of different patterns of white matter involvement in patients with brain tumors and the utility of this technique for differential diagnosis of such neoplasms. MATERIALS AND METHODS: Forty-four patients with brain tumors, including low-grade gliomas, anaplastic astrocytomas, glioblastomas multiforme and metastases, were studied with conventional and diffusion tensor magnetic resonance imaging. White matter tracts around the tumors were characterized as displaced, disrupted, infiltrated and edematous. RESULTS: A significant overlap was observed between patterns of white matter involvement on diffusion tensor images as the displaced pattern was seen in all the types of tumor. Disrupted and infiltrated patterns were found in glioblastomas multiforme and anaplastic astrocytomas. The edematous pattern was found in the cases of metastases. CONCLUSION: Diffusion tensor imaging patterns of white matter involvement assists in the mapping of tracts adjacent to tumors, providing significant data about tumors extent; however, they cannot distinguish low-grade and high-grade gliomas from metastases.

A Case of External Approach Treatment of Pott's Puffy Tumor / 대한이비인후과학회지

Pott's puffy tumor is a rare clinical entity, which has been described as a subperiosteal abscess in the frontal bone secondary to frontal osteomyelitis. Pott's puffy tumor can be associated with venous thrombosis, epidural abscess, subdural empyema, and brain abscess. In the present paper, we describe our experience of treating a 59-year old man who complained of a headache and a swelling of forehead. Because of bilateral lesion and obstruction of frontal recess, an external approach of the frontal sinus was carried out. To our knowledge, this is the first report of Pott's puffy tumor involving the bilateral frontal sinus.

A Case of Pott's Puffy Tumor as a Complication of Contralateral Frontal Sinusitis / 대한이비인후과학회지

Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with the underlying frontal osteomyelitis. It has become a rare disease entity due to the development of antibiotics. Despite its rarity, it must be managed carefully because it is often associated with significant intracranial complications. We described a 12-year-old girl with Pott's puffy tumor accompanied with epidural abscess and subdural empyema, which was considered to be caused by the contralateral frontal sinusitis. To our knowledge, a Pott's puffy tumor caused by contralateral frontal sinusitis has not been reported in the literature. We discuss the clinical presentation and successful treatment of this unique case with brief review of the literature.

Acute Frontal Osteomyelitis Managed by Endoscopic Sinus Surgery: A Case Report / 대한이비인후과학회지

Frontal osteomyelitis, frequently characterized by the classical sign of Pott's puffy tumor, is a serious life-threatening complication of frontal sinus infection. Anterior extension of the frontal sinus infection leads to osteomyelitis of the frontal bone and subperiosteal abscess. Surgical options are necessitated by the location and extent of infection, and include trephination, frontal sinus obliteration, and craniotomy. Recent advances in endoscopic sinus surgery have provided surgeons another access to the frontal recess. Examination of the frontal recess and removal of obstructive ethmoidal cells or diseased mucosa becomes feasible with nasal endoscopes. We report a recent encounter with a case of frontal osteomyelitis managed by endoscopic sinus surgery in a 22-year-old healthy male. We think that endoscopic sinus surgery is a good approach which can be carried out for the treatment of frontal sinus diseases and its complication.

A case of Pott's puffy tumor with epidural abscess / 대한이비인후과학회지

No abstract available.