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

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.

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

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

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.

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.

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!

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