Orbital Involvement in Pott's Puffy Tumor: A Systematic Review of Published Cases

Abstract

Background

Pott's puffy tumor (PPT) is a frontal subperiosteal abscess associated with underlying frontal bone osteomyelitis. It represents a well-known source of sinogenic intracranial infection, but the orbital complications related to this entity are rarely reported. The goal of this study was to characterize the orbital involvement in PPT.

Methods

We performed a systematic review through a Medline search (1950–2010). The authors reviewed all cases of PPT, selecting those explicitly describing orbital complications associated with PPT.

Results

We screened 139 articles, of which 93 reported cases of PPT. Of these, 35 articles described a total of 42 cases presenting simultaneous orbital complications. Eyelid and/or periorbital edema was the most common finding in patients with orbital involvement, and preseptal cellulitis is by far the most prevalent orbital complication in PPT. Postseptal involvement (orbital cellulitis, subperiosteal abscess of the orbit, and orbital abscess) is much rarer. Although treatment of the classic PPT is surgical, only a minority of patients with orbital infection required orbital drainage. Most reported patients made a full recovery, without permanent sequelae.

Conclusion

Orbital infections are possible in patients with PPT. In contrast to surgical treatment of the frontal subperiosteal abscess, the orbital complications can be treated conservatively most of the time. Early diagnosis and aggressive therapy of the underling PPT are essential to avoid severe local or systemic complications.

Get full access to this article

View all access options for this article.

References

Flamm

E.S.

Percivall Pott: An 18th century neurosurgeon.

J Neurosurg 76: 319–326, 1992.

Tattersall

, and Tattersall

Pott's puffy tumour.

Lancet 359: 1060–1063, 2002.

Chandler

J.R.

, Langenbrunner

D.J.

, and Stevens

E.R.

The pathogenesis of orbital complications in acute sinusitis.

Laryngoscope 80: 1414–1428, 1970.

Kim

Y.S.

, Kim

, Yoon

J.H.

, and Kim

C.H.

Paranasal sinus mucoceles with ophthalmologic manifestations: A 17-year review of 96 cases.

Am J Rhinol Allergy 25: 272–275, 2011.

Upadhyay

Recurrent Pott's puffy tumor, a rare clinical entity.

Neurol India 58: 815–817, 2010.

Escudero Estaban

, Pérez Pinas

, and Del Estad Cabello

Pott's puffy tumor: A forgotten complication of sinusitis.

Radiologia 53: 175–178, 2010. (Epub ahead of print July 24, 2010.)

Cheng

, and Vu

Pott's puffy tumor in a prematurate neonate: The new youngest case reported in the post-antibiotic era.

Orbit 28: 412–414, 2009.

Tsai

B.Y.

, Lin

K.L.

, Lin

T.Y.

. Pott's puffy tumor in children. Childs Nerv Syst 26: 53–60, 2010.

Shehu

B.B.

, and Mahmud

M.R.

Pott's puffy tumour: A case report.

Ann Afr Med 7: 138–140, 2008.

10.

Durur-Subasi

, Kantarci

, Karakaya

. Pott's puffy tumor: Multidetector computed tomography findings. J Craniofac Surg 19: 1697–1699, 2008.

11.

Karaman

, Hacizade

, Isildak

. Pott's puffy tumor. J Craniofac Surg 19: 1694–1697, 2008.

12.

Bannon

P.D.

, and McCormack

R.F.

Pott's puffy tumor and epidural abscess arising from pansinusitis.

J Emerg Med 41: 616–622, 2008.

13.

Lamoreau

K.P.

, and Fanciullo

L.M.

Pott's puffy tumour mimicking preseptal cellulitis.

Clin Exp Optom 91: 400–402, 2008.

14.

Morley

A.M.

Pott's puffy tumour: A rare but sinister cause of periorbital oedema in a child.

Eye (Lond) 23: 990–991, 2009. (Epub ahead of print May 23, 2008.)

15.

Raja

, Low

, Sastry

, and Moriarty

Pott's puffy tumor following an insect bite.

J Postgrad Med 53: 114–116, 2007.

16.

Hayek

B.R.

, Sitole

, Andreoli

. Bilateral eyelid edema and orbital cellulitis associated with Pott's puffy tumor. Ophtal Plast Reconstr Surg 23: 163–165, 2007.

17.

Kaabia

, Abdelkafi

, Bellara

. Pott's puffy tumor. A case report. Med Mal Infect 37: 350–353, 2007. (Epub ahead of print February 15, 2007.)

18.

Blackman

S.C.

, and Schleiss

M.R.

Forehead swelling caused by Pott's puffy tumor in a 9-year-old boy with sinusitis.

Pediatr Int 47: 704–707, 2005.

19.

Adame

, Hedlund

, Byington

C.L.

Sinogenic intracranial empyema in children.

Pediatrics. 116(3): e461–7, 2005 Sep.

20.

Weinberg

, Gupta

, Thomas

M.J.

. Pott's puffy tumor: Sonographic diagnosis. J Clin Ultrasound 33: 305–307, 2005.

21.

Reynolds

D.J.

, Kodsi

S.R.

, Rubin

S.E.

. Intracranial infection associated with preseptal and orbital cellulitis in the pediatric patient. J AAPOS 7: 413–417, 2003.

22.

Huijssoon

, Woerdeman

P.A.

, van Diemen-Steenvoorde

R.A.

. An 8-year-old boy with Pott's puffy tumor. Int J Pediatr Otorhinolaryngol 67: 1023–1026, 2003.

23.

Kung

S.W.

, Chan

D.T.

, Suen

P.Y.

. Pott's puffy tumour. Hon Kong Med J 8: 381–382, 2002.

24.

Chandy

, Todd

, Stucker

F.J.

. Pott's puffy tumor and epidural abscess arising from dental sepsis: A case report. Laryngoscope 111: 1732–1734, 2001.

25.

Bambakidis

N.C.

, and Cohen

A.R.

Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited.

Pediatr Neurosurg 35: 82–89, 2001.

26.

Guillén

, Brell

, Cardona

. Pott's puffy tumour: Still not an eradicated entity. Childs Nerv Syst 17: 359–362, 2001.

27.

Uren

R.F.

, and Howman-Giles

Pott's puffy tumor. Scintigraphic findings.

Clin Nucl Med 17: 724–727, 1992.

28.

Pender

E.S.

Pott's puffy tumor: A complication of frontal sinusitis.

Pediatr Emerg Care 6: 280–284, 1990.

29.

Mammen-Prasad

, Murillo

J.L.

, and Titelbaum

J.A.

Infectious disease rounds: Pott's puffy tumor with intracranial complications.

N J Med 89: 537–539, 1992.

30.

Maheshwar

A.A.

, Harris

D.A.

, Al-Mokhthar

. Pott's puffy tumour: An unusual presentation and management. J Laryngol Otol 115: 497–499, 2001.

31.

Wenig

B.L.

, Goldstein

M.N.

, and Abramson

A.L.

Frontal sinusitis and its intracranial complications.

Int J Pediatr Otorhinolaryngol 5: 258–302, 1983.

32.

Thomas

J.N.

, and Nel

J.R.

Acute spreading osteomyelitis of the skull complicating frontal sinusitis.

J Laryngol Otol 91: 55–62, 1977.

33.

Procino

N.D.

Pott's puffy tumor in a seven-year-old boy.

Ear Nose Throat J 57: 516–519, 1978.

34.

Feder

H.M.

Jr. , Cates

K.L.

, and Cementina

A.M.

Pott puffy tumor: A serious occult infection.

Pediatrics 79: 625–629, 1987.

35.

Remmler

, and Boles

Intracranial complications of frontal sinusitis.

Laryngoscope 90: 1814–1824, 1980.

36.

Hore

, Mitchell

R.B.

, Radcliffe

. Pott's puffy tumour: A rare cause of forehead swelling in a child. Int J Clin Pract 54: 267–268, 2000.

37.

Chaturvedi

V.N.

, Raizada

R.M.

, Kennedy Singh

A.K.

. Osteomyelitis of the frontal bone. Indian J Otolaryngol Head Neck Surg 56: 126–128, 2004.

38.

Osei-Yeboah

, Neeguaye

, Bulley

. Osteomyelitis of the frontal bone. Ghana Med J 41: 88–90, 2007.

39.

Monteiro

, Castillo

, André

. Tumeur de Pott, complication rare de la sinusite frontale. Fr ORL 93: 350–352, 2007.

40.

Giannoni

C.M.

, Stewart

M.G.

, and Alford

E.L.

Intracranial complications of sinusitis.

Laryngoscope 107: 863–867, 1997.

41.

Gonzales

M.O.

, and Durairaj

V.D.

Understanding pediatric bacterial preseptal and orbital cellulitis.

Middle East Afr J Ophtalmol 17: 134–137, 2010.

42.

Tovilla-Canales

J.L.

, Nava

, and Tovilla-y-Pomar

J.L.

Orbital and periorbital infections.

Curr Opin Ophthalmol 23: 335–341, 2001.

43.

Youssef

O.H.

, Stefanyszyn

M.A.

, and Bilyk

J.R.

Odontogenic orbital cellulitis.

Ophthal Plast Reconstr Surg 24: 29–35, 2008.

44.

Jain

, and Rubin

P.A.

Orbital cellulitis in children.

Int Ophthalmol Clin 41: 71–86, 2001.

45.

Rahbar

, Robson

C.D.

, Petersen

R.A.

. Management of orbital subperiosteal abscess in children. Arch Otolaryngol Head Neck Surg 127: 281–286, 2001.

46.

Hoxworth

J.M.

, and Glastonbury

C.M.

Orbital and intracranial complications of acute sinusitis.

Neuroimaging Clin N Am 20: 511–526, 2010.

47.

Brook

Microbiology and antimicrobial treatment of orbital and intracranial complications of sinusitis in children and their management.

Int J Pediatr Otorhinolaryngol 73: 1183–1186, 2009. (Epub ahead of print February 26, 2009.)

48.

Marshall

A.H.

, and Jones

N.S.

Osteomyelitis of the frontal bone secondary to frontal sinusitis.

J Laryngol Otol 114: 944–946, 2000.

49.

Sarria

J.C.

, Vidal

A.M.

, and Kimbrough

III

Haemophilus influnzae osteomyelitis in adults: A report of 4 frontal bone infections and a review of the literature.

Scand J Infect Dis 33: 263–265, 2001.