Frontal Bone Osteomyelitis

Authored by Dr Gurvinder Rull, 17 Sep 2010

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Synonyms: Pott's puffy tumour (PPT), osteomyelitis of the calvarium[1, 2]

  • This 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.[3]
  • Streptococcus milleri group is the most common pathogen.
  • Headaches
  • There may be localised swelling
  • Fever
  • Nuchal rigidity
  • Altered mental state (from subtle changes, confusion or complete coma)
  • Focal neurological signs, eg seizures[4]

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 methamfetamine abuse,[5, 6] and as a complication of dental sepsis.[7]

CT scan (with and without contrast) or MRI scan.[8] 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.

Admission with removal of the infected bone and prolonged intravenous antibiotics (eg for six weeks). Antibiotics are usually of the penicillin group, eg high dose IV benzylpenicillin for 3 weeks followed by 3 weeks of oral amoxicillin. However, all cases should be discussed with the local microbiologist and antibiotics should be altered once sensitivities are known.

  • Extension of infection, eg brain abscess[9]
  • Meningitis
  • Epidural empyema
  • Subdural empyema

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.[10]

Further reading and references

  1. Pott P. Injuries of the head from external violence. 1st ed; London: C Hitch and L Hawes (1760) 47-48

  2. Tattersall R, Tattersall R; Pott's puffy tumour. Lancet. 2002 Mar 23359(9311):1060-3.

  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.

  4. 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.

  5. Noskin GA, Kalish SB; Pott's puffy tumor: a complication of intranasal cocaine abuse. Rev Infect Dis. 1991 Jul-Aug13(4):606-8.

  6. Banooni P, Rickman LS, Ward DM; Pott puffy tumor associated with intranasal methamphetamine. JAMA. 2000 Mar 8283(10):1293.

  7. 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.

  8. 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.

  9. Tuon FF, Russo R, Nicodemo AC; Brain abscess secondary to frontal osteomyelitis. Rev Inst Med Trop Sao Paulo. 2006 Jul-Aug48(4):233-5.

  10. Percivall Pott; Whonamedit.com

After a posterior cervical fusion I contracted cervical osteomyelitis. I needed all the typical treatments, including deep debridements to the back of my neck. Most of the problems I am having are...

daniel95667
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