Author(s)
Rebecca L. Rohde, MD, MPH
Lauren M. North, MD
Molly Murray, MS
Sammy Khalili, MD, MSc, FRCSC
David Poetker, MD, MA, FARS
Affiliation(s)
Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Department of Otorhinolaryngology, Aurora Neuroscience Innovation Institute, Milwaukee, Wisconsin, USA
Abstract:
Objectives:
To provide the largest comprehensive, up-to-date, and systematic review of the essential clinical findings, diagnostic modalities, microbiologic and antimicrobial considerations, and medical and surgical treatment approaches commonly utilized in the management of Pott’s puffy tumor (PPT), in both pediatric and adult populations.
Study Design:
Systematic review.
Methods:
We conducted a systematic review of the literature through MEDLINE, PubMed, and Embase database search (1950 – 2022). The authors reviewed all cases of PPT, focusing specifically on those papers describing therapeutic management of PPT.
Results:
A total of 321 patients were included in this review, consisting of 318 (from 219 articles) and an additional 3 adult cases from our institution. PPT is a disease process characterized by osteomyelitis of the frontal bone with subperiosteal abscess formation, most often resulting from untreated rhinosinusitis. Infections are classically polymicrobial with an anaerobe-predominant microbiome requiring special considerations for antimicrobial therapy. Both MRI and CT imaging modalities are commonly obtained for pre-surgical assessment of sinusitis and intracranial extension. The core of treatment is an early and aggressive approach to prevent long-term complications. Recent literature suggests that a significant portion of patients may require endoscopic sinus surgery for successful disease resolution.
Conclusion:
PPT is an important and relatively morbid disease process that is often under-recognized and misdiagnosed at presentation due to its rarity in the antibiotic era and varied clinical presentation. This disease entity is often refractory to conventional management for rhinosinusitis due to the polymicrobial nature of these infections. Its potential for orbital and intracranial involvement remains significant. As a result, clinicians evaluating patients for PPT should maintain a high degree of suspicion for disease extension and initiate diagnostic workup and treatment on a prompt basis. Pediatric patients and those with a history of endoscopic sinus surgery demonstrate varying degrees of intracranial extension. Therefore, an individualized, targeted, and interdisciplinary approach to the treatment of PPT is critical to successful disease resolution.