Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our health articles more useful.
Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
Synonyms: Pott's puffy tumour (PPT), osteomyelitis of the calvarium 
- Frontal bone osteomyelitis is rare. It is osteomyelitis with a subperiosteal (extradural) abscess in the frontal bone.
- It usually represents an anterior extension of a frontal sinus infection or as a complication of a compound skull fracture.
- It can also be a complication of mastoiditis and has been reported following an insect bite.
- Streptococcus milleri group is the most common pathogen.
- Mucormycotic (fungal infection caused by a group of moulds called mucormycetes) osteomyelitis of the frontal bone has been reported in several patients with rhinocerebral mucormycosis, secondary to COVID infection.
Frontal bone osteomyelitis symptoms (presentation)
- There may be localised swelling.
- Nuchal rigidity.
- Altered mental state (from subtle changes, confusion or complete coma)
- Focal neurological signs, eg, seizures.
Pott's puffy tumour is a potential complication of acute frontal sinusitis, characterised by subperiosteal abscess and osteomyelitis of the frontal bone. It can be managed with a combination of open and endoscopic sinus surgery, and intravenous antibiotic therapy.
Since the advent of antibiotics, Pott's puffy tumour (PPT) has been only rarely reported (mostly in children and adolescents) but more recently has been described following intranasal and inhaled cocaine or methamphetamine abuse, and as a complication of dental sepsis.
CT scan (with and without contrast) or MRI scan. CT scan may reveal bone erosion and evidence of rim enhancing abscess formation. There may be intracranial involvement, eg, fluid collection and CT/MRI may also help in this.
Frontal bone osteomyelitis treatment and management
Admission with removal of the infected bone and prolonged intravenous antibiotics (eg, for six weeks or longer). All cases should be discussed with the local microbiologist and antibiotics should be altered once sensitivities are known.
Percivall Pott (1714-1788) was a London surgeon (St. Bartholomew's Hospital) who also gives his name to Pott's disease of the spine (spinal tuberculosis - scrofula), and to Pott's fracture (fracture dislocation of the ankle). He was first to describe an industrially acquired disease: cancer of the scrotum in chimney sweeps.
Further reading and references
Chaturvedil VN, Raizada RM, Singh AK, et al; Osteomyelitis of frontal bone. Indian J Otolaryngol Head Neck Surg. 2004 Apr56(2):126-8. doi: 10.1007/BF02974316.
Tattersall R, Tattersall R; Pott's puffy tumour. Lancet. 2002 Mar 23359(9311):1060-3.
Raja V, Low C, Sastry A, et al; Pott's puffy tumor following an insect bite. J Postgrad Med. 2007 Apr-Jun53(2):114-6.
Mavani SB, Joshi SJ; Frontal Bone Osteomyelitis: A Dreaded Complication of Post-COVID Mucormycosis. Neurol India. 2022 May-Jun70(3):1283-1284. doi: 10.4103/0028-3886.349670.
Strony RJ, Dula D; Pott puffy tumor in a 4-year-old boy presenting in status epilepticus. Pediatr Emerg Care. 2007 Nov23(11):820-2.
Tibesar RJ, Azhdam AM, Borrelli M; Pott's Puffy Tumor. Ear Nose Throat J. 2021 Sep100(6_suppl):870S-872S. doi: 10.1177/01455613211039031. Epub 2021 Aug 20.
Banooni P, Rickman LS, Ward DM; Pott puffy tumor associated with intranasal methamphetamine. JAMA. 2000 Mar 8283(10):1293.
Chandy B, Todd J, Stucker FJ, et al; Pott's puffy tumor and epidural abscess arising from dental sepsis: a case report. Laryngoscope. 2001 Oct111(10):1732-4.
McDermott C, O'Sullivan R, McMahon G; An unusual cause of headache: Pott's puffy tumour. Eur J Emerg Med. 2007 Jun14(3):170-3.
Tuon FF, Russo R, Nicodemo AC; Brain abscess secondary to frontal osteomyelitis. Rev Inst Med Trop Sao Paulo. 2006 Jul-Aug48(4):233-5.
Percivall Pott; Whonamedit.com