2021, 3(1):10-17 e-ISSN: 2674-7103

DOI: 10.37085/jmmv3.n1.2021.pp.10-17

Jornal Memorial

Medicina

Review

Pott’s puffy tumor: overview of case series

Luiz Severo Bem Junior

Márcia Noelle Cavalcante Medeiros

Luan de Sá Pinto Nóbrega Gadelha

Wagner José Raia Neri

Marie Anne Gomes Cavalcanti

¹Universidade Federal de Pernambuco, Recife, Brazil

²Faculdade de Ciências Médicas - Unifacisa, Campina Grande, Brazil

Abstract

Pott’s puffy tumor (PPT) is rare and usually seen as a complication of frontal sinusitis that has been

neglected or partially treated, resulting in subperiosteal abscess of the frontal bone with underly-

ing osteomyelitis, which can lead to life-threatening intracranial complications, such as epidural/

subdural empyema, cerebral abscess and meningitis. Given this, the purpose of the study was to

gather the most diverse cases reported together to highlight the treatment options.

Methods: This is a narrative review, starting from the search in the database PubMed, Lilacs and

Scielo from 2010 to 2020. The search focused on obtaining data on new approaches and treat-

ments established for Pott’s puffy tumor.

Results: 34 articles were included which described 58 patients with a swollen Pott tumor, occurring

predominantly in male adolescents, with streptococci (26.1%) as the main etiologic agent. Approx-

imately 84% of all patients were male subjects. The most prevalent intracranial complication was

an epidural or extradural abscess (84.2%). Regarding PTT therapy, all patients received antibiotic

(ATB) therapy, and the main empirical antimicrobial scheme used was third generation cephalo-

sporin, with vancomycin and metronidazole. In most cases, surgery was performed using several

techniques, mainly an external surgical approach, external drainage (ED) of the subperiosteal

abscess associated with endoscopic sinus surgery (ESS). In general, the prognosis was favorable,

even if neurological symptoms were present at admission.

Conclusion: Based on available literature, PPT is a profoundly serious complication, which can

be easily avoided if treated with the ATB, ED and ESS triad immediately, and, if necessary,

craniotomy.

Luiz Severo Bem Júnior

luizseverobemjunior@gmail.com

Edited by

Marcelo Moraes Valença

Keywords:

Pott's puffy tumor

Pott puffy tumor

Osteomyelitis

Sinusitis

Received: February 25, 2021

Accepted: May 15, 2021

ASAA

Bem Junior LS, Medeiros MNC, Gadelha LSPN, Neri WJR, Cavalcanti MAG

Pott’s puffy tumor: overview of case series

Introduction

n the late 18th century, Percival Pott dened a soft subperios-

teal abscess of the frontal bone related to forehead trauma

and associated with underlying osteomyelitis that he called

“puffy tumor.” The Pott’s puffy tumor (PPT) may result often

from a slow and gradual progression of a rare complication

of frontal sinusitis or trauma to the frontal bone and skull, char-

acterized by subperiosteal abscess with osteomyelitis.

The

most common symptoms are headache, periorbital edema,

fever, vomiting, periorbital swelling, fever, lethargy, purulent

rhinorrhea, and signs of meningitis or encephalitis.

2,3

It can

be found in all ages, but there is a higher incidence among

adolescents.

PPT is a risk factor for intracranial complications (epidural

abscess

5-7

, subdural abscess, acute meningitis, and frontal

lobe abscess), which have been found in about 60-85% of

patients with PPT and may be life threatening, leading to dev-

astating neurological ramications. This complication is most

frequently associated with long-term, untreated, or improperly

treated frontal sinusitis. Besides, craniofacial traumas, surgery

in the frontal region, a progressive thrombophlebitis without

bone inammation, intranasal cocaine abuse, and the several

chronic diseases that affect the innate immune response, such

as diabetes, chronic renal failure and aplastic anemia are

also potential causes of Pott’s puffy tumor.

Although rare, PPT represents an important morbidity rate with

neurological involvement in 30% to 40% of all cases of PPT

and may include motor decit, aphasia, cranial nerve palsy,

seizures, visual decit, intracranial hypertension, obtundation,

and coma.

The vast majority of patients treated appropriately

recover without long-term neurological complications and se-

quelae.

9,10

Given this, the study aims at reviewing the literature

with a focus on new approaches and treatment of this disease

over the last ten years, making correlations between articles.

Material and methods

Some steps were taken to produce this narrative review arti-

cle: such as establishing the question and objectives of the

review; the eligibility criteria; results analysis; discussion and

presentation of results, and the nal step was the production

of this article.

A narrative review was carried out based on the following

research question: what are the new approaches, and treat-

ment for PPT? This question was formulated by PICOS strategy,

where the "P" of population is patient with Pott's Puffy Tumor,

the "I" of intervention is collect information about treatments

and approaches for Pott's Puffy Tumor, the "C" of comparison

is not applicable, the "O" of outcome is show the most effec-

tive treatments and approaches for Pott's Puffy Tumor, and the

"S" of study design is an narrative review. From that question,

the keywords were selected and organized, in the PubMed

database, using the MeSh terms: (Pott's Puffy Tumor OR Pott

Puffy Tumor) AND (sinusitis AND osteomyelitis).

During the research, were Filters applied which describe some

inclusion criteria: Abstract, in the last 10 years, Humans,

English, Spanish. Thus, we selected case reports and case

series with full text availability in electronic support.

Subsequently, the search for scientic articles published in the

PubMed, Lilacs, and Scielo database was carried out, based

on the last research carried out on December 6, 2020, using

the tool “PubMed Advanced Search Builder”, to perform a

more specic search, the terms “AND” and “OR” were used

between the descriptors in the “Builder” tool, on the other plat-

forms we use the same descriptors. A total of fty-one articles

were found in this expansive search across multiple platforms.

Of this total, only one article refers to the expansive search,

forty-one articles were identied on the PubMed and ten were

secondary references in this platform. Eighteen articles were

excluded because of not meeting the inclusion criteria. Of the

thirty-four selected, four articles were a case series, and the

rest were case reports. The search strategy is described in the

PRISMA below, as the Figure 1 shows.

Figure 1 - Flowchart of the article selection process based on

the eligibility criteria of the strategy PRISMA.

ASAA

Bem Junior LS, Medeiros MNC, Gadelha LSPN, Neri WJR, Cavalcanti MAG

Pott’s puffy tumor: overview of case series

Results

Analyzing the studies included in this review, we focused on

obtaining data on new approaches and treatments estab-

lished for PPT, as reported in Table 1. We included 34 articles

that described 58 patients with Pott's puffy tumor, occurring

predominantly in adolescents, affecting the age group from

12 to 15 years more, accompanied by the pediatric age

group. Of the affected patients, approximately 84% were

male subjects. The main etiological agents most involved

with PTT were

Streptococci

(26.1%),

Fusobacterium

(19.0%),

Staphylococcus spp.

(16.6%).

Of the 34 clinical cases studied 55.8% evolved with intracrani

al complication. The most prevalent intracranial complica-

tionwas epidural abscess (84.2%), followed by subdural

abscess (15.8%), that were diagnosed, by most authors, using

computerized tomography images. In relation to treatment, all

patients received antibiotic therapy, and the main empirical

antimicrobial scheme used was cephalosporin third genera-

tion, vancomycin, and metronidazole. In general, the articles

included in this research used an external surgical approach,

mainly the external drainage of the subperiosteal abscess

associated with endoscopic sinus surgery. The success of the

treatments applied was in 100% of the cases. Figure2 shows

among all the cases analyzed in this systematic review, the

value for each type of treatment instituted.

Table 1. Characterization of publications according to author, year, methodological design, and conclusion

Author and Year Methods

Intracranial

Complication

Infectious agent Antibiotic therapy sequence Conclusion

Simonin et al.

Case Report Epidural abscess

Streptococcus

Intermedius

Ceftriaxone

Aggressive treatment with intravenous antibiotics and surgical

debridement is recommended for a patient with a history of frontal

sinusitis associated with progressive forehead swelling. May lead

to diagnosis.

Peric et al. 2017

Case Report Epidural abscess

Staphylococcus

aureus and

Peptostreptococus

prevoti

Ceftriaxone, metronidazole,

amoxicillin-clavulanate

The lesion may propagate intracranially, resulting in dangerous

intracranial inammatory lesions. Early diagnosis, medication and

surgical therapy are particularly important in reducing morbidity

and mortality.

Avcu et al.

Case Report

There was no

evidence of

intracranial

involvement.

Without abscess

culture

Ceftriaxone, Vancomycin

and metronidazole ->

Amoxicillin clavulanic

The early diagnosis and treatment of PPT are emphasized, given

that it may lead to serious complications, and this should be kept

in mind when treating patients with a history of trauma and sinusitis

who present with headache, fever and swelling in the frontal region.

Salomão et al.

Case Series

A bifrontal small-

sized epidural

empyema.

(2)

Group

beta-hemolytic

streptococci

(1)

Staphylococcus

aureus

(3) Without abscess

culture

Intravenous

broad-spectrum antibiotics

The goals of PPT management are the treatment of sinusitis with

broad-spectrum antibiotic agents, drainage of the subperiosteal

abscess, and removal of the compromised bone. If present

intracranial complication should be also promptly treated, reducing

morbidity and mortality.

Haider et al.

Case Report

Meningitis with

subdural right

temporal-parietal

empyema.

Fusobacterium

necrophorm

Cefuroxime -> meropenem

and fosfomycine ->

Meropenem, vancomycin,

and ceftriaxone ->

Meropenem and

metronidazole

The neurosurgical drainage of the subdural empyema as well as the

drainage of the subperiosteal abscess, combined with appropriate

antibiotic therapy, led to a nearly complete recovery.

Sabatiello et al.

Case Report

Subdural abscess,

and intracranial

abscess.

Peptostreptococcu,

Fusobacterium

necrophorum

Amoxicillin-clavulanate

-> Cefotaxime and

clindamycine

Treatment consists of surgical drainage of the abscess and a long-

term culture-directed intravenous and oral antibiotics course to

prevent further purulent complications.

Laguna et al.

Case Report

Right epidural

abscess, with

purulent left frontal

collection in space

subarachnoid.

Streptococcus

pyogenes

Cefotaxima and

clindamicina ->

Ciprooxacino

Concluded that a fast diagnosis of PPT and an aggressive treatment

with antibiotic agents are essential to reduce the risk of neurological

complications.

Acke et al.

Case Report

There was no

evidence of

intracranial

involvement.

Without abscess

culture

Not described

In the failure to respond to antibiotics, surgical intervention is

the treatment of choice, including drainage of the abscess and

removal of the osteomyelitic bone. Postoperatively, the patient

should be given appropriate antibiotic medication for a period

of 6 to 8 weeks.

Patel et al.

Case Report

There was no

evidence of

intracranial

involvement.

Without abscess

culture

Ceftriaxone, vancomycin,

and metronidazole->

Amoxicillin/clavulanate

Barosinusitis can be associated with potentially dangerous

intracranial complications, early recognition, diagnosis, and

appropriate treatment are of vital importance to reduce morbidity

and mortality.

Casado Pellejero

et al.

Case Report

Epidural abscess,

and subdural

abscess.

Propionibacterium

acnes, Actinomyces

sp and

Fusobacterium

nucleatum

Vancomicina, ceftazidima

and metronidazol ->

Amoxicilina

Early surgery and starting intravenous antibiotic therapy early

are effective curative treatments, avoiding the spread of infection.

Rehman et al.

Case Report

There was no

evidence of

intracranial

involvement.

Without abscess

culture

Intravenous

broad-spectrum antibiotics

A Pott puffy tumor, although exceedingly rare, may still occasionally

be seen. Prompt diagnosis and proper treatment will decrease the

morbidity and mortality associated with this rare condition.

Suwan et al.

Case Report Epidural abscess.

Streptococcus

constellatus,

Fusobacterium

necrophorum

Cefdinir, vancomycin,

cefotaxime, and

metronidazole -> Ampicillin

sulbactam -> Intravenous

meropenem

Prompt surgical and medical treatments are the rule, essential in

achieving an ideal result, as there is the potential for signicant

morbidity if not quickly diagnosed and treated.

ASAA

Bem Junior LS, Medeiros MNC, Gadelha LSPN, Neri WJR, Cavalcanti MAG

Pott’s puffy tumor: overview of case series

Joo et al.

Case Report

There was no

evidence of

intracranial

involvement.

Without abscess

culture

Cetirizine -> Ampicillin/

sulbactam -> Amoxicillin/

clavulanate

Pott’s puffy tumor is best diagnosed with computerized tomography

(CT) and treated with early broad-spectrum antibiotics and surgical

approach to prevent morbidity and mortality.

Grewal et al.

Case Report

There was no

evidence of

intracranial

involvement.

Eubacterium

species and

Coagulase negative

Staphylococci

Vancomycin, ceftazidime,

and metronidazole ->

Clindamycin

Pott’s puffy tumor is an extremely serious complication which can

be easily prevented by adequate and appropriate treatment of

acute bacterial sinusitis currently.

Sharma et al.

Case Report Epidural abscess.

Streptococcus

intermedius

Not described

Early diagnosis and treatment are required for Pott’s Puffy Tumor.

Broad-spectrum antibiotics for 4 to 6 weeks, along with surgical

drainage, is the standard of treatment.

Jung et al.

Case Report

There was no

evidence of

intracranial

involvement.

Staphylococcus

aureus

Ceftriaxone

Once the diagnosis is suspected, appropriate imaging should be

performed to evaluate the possible complications and combine

medical and surgical approaches.

Lauria et al.

Case Report

There was no

evidence of

intracranial

involvement.

Streptococcus

constellatus

Amoxicillin-clavulanate ->

Metronidazole, vancomycin,

and ceftazidime ->

Ampicillin-sulbactam

Early diagnosis of Pott puffy tumor and aggressive medical and

surgical approach are essential for a good outcome.

Podolsky-Gondim

et al.

Case Report Epidural abscess.

Peptostreptococcus

species

Ceftriaxone, oxacillin,

and metronidazole ->

Amoxicillin

with clavulanic

Early clinical suspicion, diagnosis, and the treatment of the frontal

sinusitis and its complications with surgery and broad-spectrum

intravenous antibiotics bring up the possibility of good recovery,

with prognosis is favorable

R. Escudero

Esteban et al.

Case Report

Right and left

frontal epidural

abscesses.

Streptococo

intermedius

Penicillin

Epidural abscesses were evacuated and after surgery, they were

treated for 6 weeks with penicillin. Partially treated frontal sinusitis

can lead to this potentially dangerous complication. Proper

diagnosis and treatment improve outcomes in these patients

Shahzeb Hassan

et al.

Case Report

Tiny epidural

collection with

associated Dural

thickening.

Fusobacterium

nucleatum

Vancomycin and ampicillin-

sulbactam -> Ceftriaxone

and metronidazole

This type of patient with an orbital fracture and hematoma can be

initially evaluated and managed by an ophthalmologist. Although

these are generally rare and serious cases, immediate evaluation

with a multidisciplinary approach can generate promising results.

Antonio Pansini,

et al.

Case Report

There was no

evidence of

intracranial

involvement.

Staphylococcus

aureus

Amoxicillin-clavulanic

Combined medical and surgical treatment is the gold standard

in managing PTT. Antibiotic therapy should be done with broad-

spectrum antibiotics and then be based on microbiological

examination. Surgery must be radical, an open and combined

endoscopic approach is usually necessary and must restore the

patency of the sinus ostium.

Blumeld E, Misra

Case Series

Epidural abscess

(four cases out

of ve)

Without abscess

culture

Not described

A high index of suspicion is needed, the use of image methods is

crucial and a multidisciplinary team is imperative.

Parida PK et al.

Case Series.

There was no

evidence of

intracranial

involvement.

Three cases

reported sterile

cultures, meanwhile

one case reported

MRSA and another

one reported

Pseudomonas

aeruginosa

Ceftriaxone, crystalline

penicillin, metronidazole,

vancomycin and

ceftazidime were used

without a clear antibiotic

therapy sequence.

Early tratment results in favorable outcomes and decreases the risk

of futher complications.

Burak Olmaz

et al.

Case Report

Epidural abscess

extension.

Without abscess

culture

Amoxicillin cavulanate ->

Ceftriaxone -> Vancomycin,

metronidazole and

Ceftriaxone

The imaging role in PPT's diagnosis and intracranial complication

detection is crucial

Sekine R et al.

Case

Report.

Epidural abscess.

Stenotrophomonas

maltophilia,

Achromobacter

xylosoxidans, and

Corynebacterium

spp

Vancomycin -> Levooxacin

Antibiotics and surgical approach are both vital therapys in PTT

cases

Bannon PD,

Mccomarck RF

Case

Report.

There was no

evidence of

intracranial

involvement

Streptococcus

intermedius

Ampicillin/Sulbactan

-> amoxicillin/

clavulanate potassium ->

vancomycin, ceftriaxone

and metronidazole

-> ceftriaxone and

metronidazole

Intravenous antibiotics and surgery are importants steps in PPT

treatment.

Ciobanu AM

et al.

Case Report

There was no

evidence of

intracranial

involvement

Mycoplasma

Doxycycline PPT began to be reported more frequently in recent years.

Zhang SY, Deng

Case Report

There was no

evidence of

intracranial

involvement

Klebsilla

pneumoniae

Not described

PPT is a pathology that is difcult to diagnose and requires great

clinical accuracy.

Palabiyik FB et

al.

Case Series

Epidural abscess

(two cases)

Staphylococcus

epidermidis

(one

case),

E. coli (

one

case),

Sterille (four

cases)

Ampicillin/sulbactan

and metronidazole or

ceftriaxone -> and then

changed according to the

results of the pus culture.

Conrm the association of PPT and intracranial complications

Şimşek H

Case Report

There was no

evidence of

intracranial

involvement

Pseuodomonas

aeruginosa

Ceftriaxone and

metronidazole ->

ciprooxacin

In the surgical approach, it's important to remove osteomyelitic

bone extended to the healthy margins.

Clarós P, Ahmed

H, Clarós A.

Case report

There was no

evidence of

intracranial

involvement

Bacteriological

culture of the

aspiration sample

remained sterile.

Ciprooxacin

As in the case reported here, culture can remain sterile. Miloundja

et al. reported 50% of sterile culture results, reecting preoperative

use of empirical intravenous antibiotics, which sterilizes the site

of infection.

ASAA

Bem Junior LS, Medeiros MNC, Gadelha LSPN, Neri WJR, Cavalcanti MAG

Pott’s puffy tumor: overview of case series

Discussion

Pott’s puffy tumor consists of a subperiosteal abscess with

osteomyelitis of the frontal bone.

PTT is commonly related

as a complication of a frontal or ethmoidal sinusitis, acute or

chronic, but can see cases related after front bone trauma

11,

12,29

, and even barotrauma can be associated.

PPT is a

disease with low incidence and with few cases reported;

this can be explained nowadays due to the widespread use

of antibiotics.

The prevalence of PTT is higher among teenagers, because

the venous drainage by diploic veins ow is increased during

this stage of life, and can spread the infection easier,

other

possible causes of this epidemiology is an anatomical char-

acteristic, like late complete aeration of the frontal sinus

3,8,13,14

which are often pneumatized by 2 years of age and are

approximate adult size by the late teens.

But adults can be

affected by the PTT, although rare, according to the world

English-language literature, only 30-40 cases of adult patients

with PPT were reported between 1990 and 2016.

The bacterial agents most often involved with PPT are

Strep-

tococci (Streptococcus milleri, Streptococcus viridians, Strep-

tococcus pyogenes e Streptococcus pneumoniae), Staphylo-

coccus aureus

, and some anaerobic bacteria (Bacteroides

and

Fusobacterium

14,20,26,33

Mycoplasma

Klebisiella pneu-

moniae

and

Pseuodomonas aeruginosa

). These agents are

the most common ones found in acute bacterial rhinosinusitis;

an important fact is that most infections are caused by more

than one etiologic agent.

This infectious agent propagating

through mucosal venous drainage of the frontal sinus occurs

through the diploic veins, which communicate with the Du-

ral venous plexus or directly by erosion of the frontal sinus

wall.

3,14,15

However, there is a possibility that the microbial

study of purulent secretion may be uncontaminated, Clarós et

al.

reported 50% of sterile culture results, reecting preoper-

Linton S, Pearman

A, joganathan V,

Karagama Y.

Case report

There was no

evidence of

intracranial

involvement

Without abscess

culture

Coamoxiclav and

metronidazole

Intracranial and intraorbital collections require urgent

surgical drainage along with combined sinus trephination.

Sheth SP, Ilkanich

P, Congeni B.

Cases

report

Case 1 - Subdural

abscess; Case

2 - There was no

evidence of

intracranial

involvement Case

3 - Epidural

abscess

Case 1 e 2

Fusobacterium

necrophorum. Case

3 - F. necrophorum,

F streptoccoci and

Streptococcus

constellatus

Case 1 - Empiric

vancomycin, ceftriaxone

and piperacillina,

tazobactam; Case 2 -

Vancomycin, clindamycin

and ceftriaxone; Case

3 - Amoxicillin-clavulanic

acid, levooxacin and

vancomycin

The pathogens seen do not reect the etiology of sinusitis in general.

Shin JW et al.

Case report

Epidural

abscess

Staphylococcus

aureus and

coagulase-negative

Third generation of

cephalosporin

The PPT, known as a giant frontal mucocele, is an

uncommon disease entity and more rarely reported with its

frontocutaneous stula

Figure 1. Treatment of each case analyzed. ATB= antibiotic therapy; ED = external drainage; ESS = endoscopic sinus surgery.

ASAA

Bem Junior LS, Medeiros MNC, Gadelha LSPN, Neri WJR, Cavalcanti MAG

Pott’s puffy tumor: overview of case series

ative use of empirical intravenous antibiotics, which sterilizes

the site of infection.

It is necessary to understand the PPT itself as a complication

of an initial bacterial colonization, so that there will be the

formation of an intense inammatory process and symptoms

associated with both this inammation and the topography

of the PPT. The presentation of the patient will occur with

local edema, headache, and fever in its entirety, and may

also present cutaneous stulations

, lowering the level of

consciousness and hemodynamic instability.

1,19

One of the main factors involved in the etiology of PPT is

osteomyelitis of the frontal bone, which presupposes the

occurrence of complications that affect intracranial content

by extension, with data in literature that supports an uncer-

tain risk, which varies from approximately 30%

to 80%

The main reported complication is epidural abscess. Other

complications reported in literature are subdural abscess,

cerebral abscess and meningitis, these complications require

a differentiated and individualized approach that are not the

focus of this study.

Despite the non-observed relation between the risk-factors

and PPT, correct and early diagnosis is important to avoid the

occurrence of intracranial complication, being an important

risk-factor itself.

In the event of suspecting PPT, the diagnosis should be per-

formed early. A CT scan with intravenous contrast enhance-

ment includes adequate information on the intracranial as

well as extracranial complications of frontal sinusitis but is

mostly superior to an MRI in visualization of the bone.

3,19,21

However, MRI after an intravenous gadolinium injection

showed more detail in the description of the extent of the

disease and enables better evaluation of the underlying

subdural space and brain. A scintigraphy evaluation can be

useful in detecting and diagnosis of osteomyelitis.

In addi-

tion, the ultrasound forehead images can assist in the initial

radiological investigation and guide the needle sampling

for culture.

The physiopathology of PPT made the necessity of immedi-

ate antibiotic therapy and the improvement based on the

study of the pathogens clear. The antimicrobial agent used

will vary according the local epidemiology, but the most

prevalent drugs used long-term (not less than 8 weeks)

according our research, are ceftriaxone, metronidazole, and

vancomycin.

1,5,29

The surgical treatment involves logical steps but will change

depending on the complications of each case. It is necessary

to make sure there will not be any material infected that could

cause recurrence. The main treatment consists of a bi-coronal

incision, follow by a craniotomy and drainage of purulent

material, removal of infected soft tissues and debridement of

the osteomyelitic focus. Furthermore, another safe procedure,

a valuable technique, made to ensure the efcacy of treat-

ment was the endoscopic approach of the anterior ethmoid

cells, sometimes amplied for the maxillary sinus.

8,14,16,21

The

choice of the surgical procedure depends on the extent of the

infection, as reported in Graph 1.

14,20,22

To increase the chances of a good prognosis, PPT should be

suspected in all patients with sinusitis

, treatment must take into

account the multidisciplinary approach, involving the ophthal-

mological vision

, that of the otolaryngologist, maxillofacial

surgeon, neurosurgeon and the anesthetist, everyone can

and should contribute to the patient's favorable evolution.

In general, the prognosis is favorable, even if neurological

symptoms are present upon admission, obviously, prompt

diagnosis and aggressive treatment is mandatory in these

cases for successful outcomes.

19,25,32,36

Conclusion

Therefore, the PPT has its incidence decreasing, justied by

the correct use of antibiotics. However, it can be lethal if it

is not diagnosed.

Furthermore, it is a very serious complication, which can be

easily avoided with the appropriate treatment that includes

the early use of antibiotics, with the aim of covering the

associated pathogens, while the surgical approach, should

always be evaluated, prioritizing the treatment triad: antibiotic

therapy, external drainage and endoscopy of the affected

sinuses, and, if necessary, craniotomy, which aim to reduce

the damage caused by complications. Thus, the conclusions

are consistent with the evidence presented.

Luiz Severo Bem Junior

https://orcid.org/0000-0002-0835-5995

Márcia Noelle Cavalcante Medeiros

https://orcid.org/0000-0002-8663-6135

Luan de Sá Pinto Nóbrega Gadelha

http://orcid.org/0000-0002-8806-0651

Wagner José Raia Neri

https://orcid.org/0000-0002-4026-6271

Marie Anne Gomes Cavalcanti

https://orcid.org/0000-0003-0212-9679

ASAA

Bem Junior LS, Medeiros MNC, Gadelha LSPN, Neri WJR, Cavalcanti MAG

Pott’s puffy tumor: overview of case series

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