Pott’s Puffy Tumor

Pott’s Puffy Tumor — Kevin M. Partlow, RN

Children are resilient. Children are tough. Human development leads us through many different stages, one of which is early childhood. In early childhood children explore the world and in doing so present to their parents with the strangest of situations. Sometimes it is a cut that seemingly came from nowhere. Other times it may be a bruise or a bug bite that seems to appear overnight. Parents rely on their pediatricians to help them understand many of the health-related mysteries of childhood. A mere internet search of your child’s rash may lead you to believe the worst only to speak with your pediatrician and find out that a different detergent is all that is needed. It is also important to note that sometimes it is the seemingly small things that turn out to be the real concern. One example is Pott’s Puffy Tumor. Pott’s Puffy Tumor is swelling of the forehead that is caused by infection of the frontal bone. Bone infection is called osteomyelitis and in this case can come from a sinus infection that has spread to the bone.

What to Look For

A parent may notice that their child has forehead swelling and may or may not have a fever and nasal congestion and think that it is nothing more than the cold and a fall that bumped their child’s head. Boys are often attributed by parents as being clumsy or rough with play. It should also be noted that males have a greater tendency toward getting Pott’s Puffy Tumor. The pediatrician should immediately consider Pott’s Puffy Tumor as early recognition is very important. The pediatrician will be able to assess carefully and determine if a CT scan would be beneficial. If the Pediatrician is unable to rule out Pott’s Puffy Tumor with a good history and physical exam then they would consider a CT with contrast of the head in order to be able to see the brain and sinuses. 

This abscess causes the swelling of the forehead and therefore is a sign that an infection is already at a dangerous point.

Pott's Puffy Tumor in an adolescent

Strong antibiotics may be deemed appropriate as this condition is related to a bone infection (osteomyelitis) that causes an abscess. This abscess causes the swelling of the forehead and therefore is a sign that an infection is already at a dangerous point. There is also the danger of the swelling itself putting pressure in unsafe places. In the setting of Pott’s Puffy Tumor, a strong broad-spectrum antibiotic is necessary to fight the infection. Depending on the severity and location of the swelling there may also be need for surgical intervention. Sinus wash out may be all that is needed or there may even be need for a craniotomy which is a more invasive surgery to remove the fluid and relieve the pressure.

Early Identification is Paramount

Early identification and treatment is key with Pott’s Puffy Tumor. Parents have to be vigilant in identifying changes in their children, but they are not expected to be able to diagnose them. Pott’s Puffy Tumor may not be a disease that Pediatricians see daily but it certainly should be considered when the telltale sign of forehead swelling is present. Sometimes a disease process can hide in plain sight and Pott’s Puffy Tumor definitely qualifies.

Photo source: Royal College of Emergency Medicine, https://emj.bmj.com/content/27/7/521.

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