Pott’s Puffy Tumour
Frontal bone osteomyelitis with a subperiosteal abscess, most often arising as a complication of frontal sinusitis. Although uncommon, it carries a high risk of intracranial extension (meningitis, empyema, cerebral abscess, cerebral venous sinus thrombosis) and therefore demands prompt recognition, urgent imaging and rapid specialist referral.
Definition and significance
Pott’s puffy tumour is osteomyelitis of the frontal bone with an associated subperiosteal abscess, usually secondary to frontal sinusitis. Because of the risk of intracranial complications, early diagnosis, urgent imaging and combined specialist management (ENT ± neurosurgery; paediatrics for children) are essential.
Epidemiology
- Predominantly affects adolescents with a mean age around 13 years.
- There is a strong male predominance of approximately 5:1.
- Common antecedents include untreated or partially treated frontal sinusitis and minor head trauma.
- Other associations include recent frontal sinus surgery, dental infection, intranasal substance misuse and iatrogenic spread.
Clinical features
- Well‑circumscribed, tender, fluctuant swelling of the forehead over the frontal bone.
- Frontal headache and fever are common.
- Nasal symptoms may be present but can be minimal or absent.
- Atypical presentations such as isolated severe headache or subtle local signs are common and may delay diagnosis.
- Signs suggestive of intracranial involvement include neck stiffness, photophobia, altered consciousness, focal neurological deficits and seizures.