Potts Puffy Tumour- a Diagnosis not to be Forgotten

Case Report

Austin J Otolaryngol. 2015; 2(7): 1052.

Potts Puffy Tumour- a Diagnosis not to be Forgotten

Bhavesh Patel*, Richard Fox and Issa Beegun

Department of Surgery and Cancer, Imperial College London, UK Department of Otolaryngology, Head and Neck Surgery, West Middlesex University Hospital, UK

*Corresponding author: Bhavesh Patel, Clinical Research Fellow, Department of Surgery and Cancer, St Marys Campus, Imperial College London, UK

Received: June 12, 2015; Accepted: September 02, 2015; Published: September 05, 2015

Abstract

An 80-year-old women, with a history of chronic rhinosinusitis, presented to the Accident and Emergency department with a one week history of right sided supra and infraorbital swelling, tenderness and erythema. Her symptoms began with swelling and erythema above her right eye. This spread to involve the right infraorbital region and across the right side of her right cheek.

Examination revealed a boggy tender swelling in the supraorbital region with surrounding erythema, confirmed to be a Potts Puffy tumour on Sinus CT.

She was managed with Intravenous antibiotics, analgesia, nasal douches and decongestants and the lesion was treated surgically with incision and drainage. The patient was well post-operatively and at initial follow-up. Frontomaxillary balloon sinuplasty was performed two months later and the patient reported good symptomatic relief at 6-month review.

Background

Pott’s Puffy Tumour (PPT) is a rare clinical condition first described by Sir Pervical Pott in 1760 [1] as ‘a puffy, circumscribed, indolent tumour of the scalp, and a spontaneous separation of the pericranium from the scull (sic.) under such a tumour’ [2]. It is defined as a subperiosteal abscess of the frontal bone with associated osteomyelitis. It can arise as a result of trauma or, more commonly, from chronic frontal sinusitis.

Chronic Sinusitis is a common condition with a prevalence of approximately 11% in the United Kingdom [3]. Alongside periorbital cellulitis; orbital, epidural, subdural and cerebral abscesses; meningitis and cavernous sinus thrombosis, PPT is one of the more serious complications of sinusitis. Although the prevalence and mortality from PTT has reduced considerably since the advent of antibiotics [4], prompt recognition and treatment is important to prevent disastrous progression of the condition.

We describe a rare case of PTT in an elderly patient with a history of Chronic Sinusitis. The case illustrates how the rare and subtle presentation of PTT challenges its prompt diagnosis. Although few clinicians will have encountered the condition, it is important remember PPT as a differential in children and adults with a history of chronic sinusitis presenting with a new forehead swelling and to investigate and manage them accordingly.

Case Presentation

An 80-year-old woman presented to the Accident and Emergency department with a one week history of right sided supra and infraorbital swelling, tenderness and erythema. Over this time the supraorbital swelling had developed a central prominence that had produced a discharging sinus, healed with a scab at presentation. She was afebrile and systemically well. She was otherwise fit and well, with no history of diabetes, immunosuppression or smoking and on no regular medications.

On examination, all eye movements were normal and there was no conjunctival ecchymosis. A boggy tender swelling with surrounding erythema was noted in the supraorbital region with a central scab over the most prominent erythematous area (Figures 1-4). Anterior and posterior Rhinoscopy via flexible nasendoscope was unremarkable.