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Background Pott’s puffy tumor (PPT) is a rare and potentially deadly complication of frontal sinusitis consisting of subperiosteal abscess and osteomyelitis of the frontal bone. Case presentation We report the case of a 9-year-old boy who presented with fever and soft tissue swelling of the forehead. Magnetic resonance imaging (MRI) depicted an abscess in the subcutaneous tissue frontally and an epidural empyema, while a cranial computed tomography (CT) scan revealed bone erosion as a sign of osteomyelitis. The patient was treated accordingly. Conclusions This rare condition is essential to keep in mind as it needs a multidisciplinary approach and relevant imaging to start proper treatment and thus decrease the risk of intracranial complications.

A 37-year-old woman presented to the department of otolaryngology with a 15-day history of frontal headache. The patient had been treated for sinusitis with a 10-day course of amoxicillin and clavulanic acid without any improvement. Five days before presentation, a well-defined, fluctuating forehead swelling had developed. The patient was afebrile and fully alert and oriented. Nasal endoscopy showed bilateral mucopurulent discharge. The neurologic examination was unremarkable. Magnetic resonance imaging (MRI) showed bilateral opacification of all paranasal sinuses, osteomyelitis of the frontal bone with erosion of anterior frontal sinus wall and the presence of a subperiosteal abscess in the patient's forehead. Koltsidopoulos et al diagnosed acute sinusitis complicated with Pott puffy tumor. They took a combined endoscopic and external surgical approach, with drainage of the abscess and débridement of necrotic material. Early diagnosis and immediate management are essential to avoid intracranial complications.

Prolonged patient follow-up is needed to determine whether further operative frontal sinus endonasal drainage or debridement, 1 or sinus obliteration, 2 is required for long term disease management.

Bloods showed haemoglobin 115 g/L, white blood cell count 10.49x109/L, neutrophils 7.34x109, C reactive protein 85 mg/L.

A Pott's puffy tumour is a subperiosteal abscess and osteomyelitis of the frontal bone secondary to frontal sinusitis. Intracranial complications are seen in approximately 40 per cent of cases and are potentially life-threatening; such complications have not previously been reported in pregnancy. A 21-year-old woman at 35 weeks' gestation presented with a history of frontal headaches and swelling, periorbital oedema, pain and chemosis. Imaging confirmed Pott's puffy tumour with right-sided epidural empyema and periorbital cellulitis. A multidisciplinary team was involved in the patient's management. Intravenous antibiotics were commenced and initial percutaneous drainage through the frontal sinus skin was performed, followed by endoscopic sinus drainage. A caesarean section was performed 3 days later. Complete resolution of the sinus and intracranial collections was noted on imaging performed six weeks later. This case highlights the challenges of managing rare intracranial complications of sinusitis in pregnancy, and the importance of multidisciplinary care.

Pott’s puffy tumour occurs as a result of infection spreading via the venous drainage of the frontal sinus or from direct extension of the infection through the bone, resulting in osteomyelitis of the frontal bone and formation of subperiosteal abscesses.2 It is more commonly associated with the adolescent age group and is rarely seen in adults.3 Pott’s puffy tumour is a risk factor for intracranial complications such as extradural abscess, subdural empyema and intracerebral abscess. The goal of surgery is to drain the sinus, remove infected bone or granulation tissue and ventilate the frontal sinus.7 An external fronto-ethmoidectomy has been performed historically, however with advancement in technology, intranasal endoscopic sinus surgery in addition to percutaneous drainage has been performed with positive results.6 Patient’s perspective I cannot commend the hospital highly enough for the swift and thorough care that I received, thank you! Pott’s puffy tumour is a significant risk factor for a range of intracranial complication secondary to thrombophlebitis of valveless diploic veins or direct spread from osteomyelitis of the posterior wall of the frontal sinus.

Notably, he had a background of chronic rhinosinusitis with nasal polyposis, treated previously with endoscopic sinus surgery and polypectomy some 4 years prior, and described an exacerbation of his sinonasal symptoms over the proceeding weeks.

Pott puffy tumor, a rare complication of sinusitis in adults, appears as a localized swelling over the frontal region or forehead. This swelling is due to a subperiosteal abscess resulting from osteomyelitis of the underlying frontal bone. This condition may be associated with an epidural purulent collection, subdural empyema, and intracerebral abscess. This entity is rare--even forgotten--since the advent of modern powerful antibiotics. A 27-year-old male was referred to ENT OPD with forehead swelling, fever and headache. The patient had mooth doughy swelling of the foreheadwith surrounding cellulitis and swelling spreading to the orbits as periorbital odema. On examination, patient had very poor oral hygiene with severe dental caries. CT with contrast conformed pansinusitis with erosion of frontal bone and abscess. An early recognition of this forgotten complication of sinusitis will help avoid severe neurological sequelae and increased morbidity and mortality.