Allergy, Nose & Sinus

Pott’s Puffy Tumour – A rare but serious complication of sinusitis! (WARNING – GRAPHIC MEDICAL IMAGES)

February 10, 2020
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Sinusitis (infection of the sinuses) is a common condition, affecting up to 15% of the population. The symptoms can be similar to that of a common cold or flu. In fact, patients with sinusitis visiting Dr Gan would often complain of having “frequent cold/flu” or having “a cold/flu that never really goes away”. As sinuses are close to the eyes and brain, if left untreated, some sinus infections can potentially spread to these major organs. Dr Gan shares his experience of managing a recent patient with sinusitis that resulted in a rare local complication close to the patient’s brain.



Mr A is a 62 year old man who had a sudden onset of headache in the forehead region and a painful swelling over his forehead which started about a week ago.  He has had intermittent blocked nose and experienced “frequent colds/flu” for many years. On examination, there was a tense, tender swelling over his forehead.



Potts Puffy Tumour


Potts Puffy Tumour 2

A doughy tender swelling on the forehead of the patient which is classical of the appearance of a Pott’s Puffy tumour



A scope through his nose showed some pus close to his sinuses.



Light Sinus Drainage

Nasoendoscopic picture of the left nasal cavity showing pus in the middle meatus (drainage area for most sinuses)




Nasoendoscopic picture showing more pus at the back end of the middle meatus



Nasoendoscopic picture

Nasoendoscopic picture of the back of the nasal cavity showing more pus



A CT scan (special series of X-rays) of his nose and sinuses showed severe infection in his sinuses.  The infection in his forehead sinuses (known as the frontal sinus) has eroded through his forehead bone resulting in a collection of pus under his forehead skin. Fortunately for him he sought treatment in time before the infection erodes the wall that separates the sinuses from the brain. If this has happened, it could lead to a severe brain infection.



CT scan side view of the head

A CT scan of the side view of the head & sinuses showing the collection of pus under the forehead skin, a break in the bone of the forehead sinus and hard bone in the drainage pathway of the frontal recess



Mr A underwent emergency sinus surgery (through the nose) with Dr Gan, combined with an external drainage of the collection of pus on his forehead with his Facial Plastic ENT colleague. As there was hard bone in the drainage pathway of his frontal recess, the bone had to be drilled away. The infected bone and the soft tissue in his forehead were also debrided. Post surgery, Mr A was given 6 weeks of intravenous antibiotics (antibiotics administered into his vein). He was last seen about a month after the surgery, during which he was recovering well.



Image Guidance System

An Image Guidance System (IGS) picture taken during surgery (with the green cross marking the position of the dissection instrument in the frontal sinus.



Mr A’s clinical condition is known as Pott’s Puffy tumour. It refers to a severe sinus infection of the forehead sinus (frontal sinus) that has causes infection of the bone and a collection of pus under the forehead skin. Sometimes, the infection may spread backwards, causing a collection of pus in the brain. This is a rare but potentially life-threatening complication of sinusitis, fortunately not commonly encountered in Singapore!

    When Should You See an ENT Specialist in Singapore?

    • Any ear, nose or throat symptoms that you are troubled with or concerned about
    • Persistent blocked nose with mouth breathing or snoring

    Dr Gan Eng Cern

    Dr Gan Eng Cern is a distinguished ENT doctor with fellowship training. In addition to his clinical practice as an ear, nose and throat specialist in Singapore, Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.


    • 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
    • 2016 – Best Educator Award (Eastern Health Alliance)
    • 2016 – “Wow” Award (Patient Compliment)
    • 2014 – Eastern Health Alliance Caring Award – Silver
    • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
    • 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
    • 2007 – Singhealth Best Doctor Award


    • MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
    • MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
    • MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
    • FAMS – Fellow of the Academy of Medicine Singapore

    Why Choose Dr Gan Eng Cern


    Reliable & Reputable ENT Expert

    Experienced and patient ENT Specialist who has your best interests at heart. We aim to provide you with accessible and specialized care for any ENT condition in a comfortable setting.


    Friendly & Helpful Clinic Staff

    Our friendly staff will assist you to the best of our ability and we are happy to accept most insurance providers and assist with E-filing with relevant insurance providers or Medisave.


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    Our ENT Specialist, Dr Gan Eng Cern, will be able to diagnose and offer personalised treatments for your specific ENT condition. You can expect a high level of ENT care in a spacious setting with in-house minor surgical, endoscopy, allergy testing and microscopy services.


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