Pott's puffy tumor treated endoscopically in an 84 Y/O/F: A
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An 84-year-old female presented with a two-day history of left forehead swelling and throbbing pain around her left eye that was progressively worsening. She had been treated for sinusitis four weeks prior with 2 weeks of oral antibiotics (amoxicillin and clavulanic acid). Her clinical symptoms of sinus congestion with purulent rhinorrhea and headache had improved until this episode. She had a past medical history of hyperlipidemia and osteoarthritis but was otherwise healthy with no history of head trauma.

On presentation, her physical examination was significant for erythematous fluctuant soft tissue swelling above the left eyebrow into the forehead. There was left periorbital edema and erythema with partial upper lid ptosis from the swelling. Her vision was grossly intact and no cranial nerve deficits were identified. She was afebrile and laboratory analysis showed a normal WBC of 8.5 × 103/L.

CT maxillofacial without contrast showed complete opacification of the left frontal sinus with erosion of the anterior wall and overlying soft tissue swelling. The opacification extended into the anterior ethmoids and there was mucosal thickening of the left maxillary sinus. The posterior frontal sinus table was intact and there was no evidence of intracranial extension.

The diagnosis of Pott's puffy tumor was made, and the patient was admitted for IV antibiotic therapy with cefepime. The following day, she was taken to the operating room for endoscopic left frontal sinusotomy, ethmoidectomy and maxillary antrostomy. The left frontal sinus was occluded with severe polypoid mucosal edema. When the natural ostium was opened, a large quantity of purulent drainage was encountered and evacuated. Additional purulent material was expressed from the surgically enlarged frontal ostium through palpation of the soft tissue overlying the left forehead. Cultures taken at the time of surgery were negative.

The patient remained in the hospital for 2 days following surgery and was then discharged home to receive 6 weeks of IV cefepime through home health services. During this period, she used a sinus rinse bottle to irrigate her sinuses with topical antibiotic and steroid saline solution twice a day. Her facial swelling and pain completely resolved within 1 week after discharge from the hospital. In follow up over the next year, the patient has remained symptom free with no evidence of recurrent sinusitis.

source: https://www.sciencedirect.com/science/article/pii/S2468548820300618
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