Pott's Puffy Tumor

What is Pott’s puffy tumor?

Pott’s puffy tumor describes an infection of your frontal bone (forehead) along with an abscess that develops in the space between your eyeballs. It’s usually a complication of sinus infections. But it can also happen after trauma to the area (like getting hit in the head).

People with Pott’s puffy tumor develop a noticeable lump on their foreheads. But despite the condition’s name, this swelling isn’t actually a tumor — or cancer. It’s a bone infection that results in a collection of infected fluid. The condition got its name from Sir Percivall Pott, the 18^th-century English surgeon who first described it.

Without treatment, Pott’s puffy tumor can lead to life-threatening complications within your skull. This is a potentially fatal condition that requires immediate medical care.

How common is this condition?

Pott’s puffy tumor is rare today because antibiotics usually fight off the infection before it spreads. The condition can affect anyone, but it’s most common in teens. This is likely due to changes in the diploic veins (the veins that connect the inner and outer parts of your skull) during adolescence. The increased development of blood vessels (vascularization) that occurs during this stage may cause infection to travel faster than it would in an adult.

What are the symptoms of Pott’s puffy tumor?

In addition to forehead swelling, Pott’s puffy tumor symptoms may include:

• Fever.
• Headaches.
• Light sensitivity.
• Nose drainage.
• Pain when pressing on the area.
• Proptosis (bulging eyes).
• Tenderness around your frontal sinuses (above the bridge of your nose and along the inner part of your eyebrows).

What causes Pott’s puffy tumor?

Sinusitis is the most common cause of Pott’s puffy tumor. Head trauma, like falling and hitting your head, is the second most common cause.

Less common causes include:

• Dental infections.
• Insect bites.
• Snorting cocaine.

Risk factors

A risk factor is something that increases your chances of developing a certain condition. For Pott’s puffy tumor, this includes health issues that affect the way your immune system responds to infection. Examples include:

• Aplastic anemia.
• Diabetes.
• Kidney failure.

What are complications of this condition?

Left untreated, Pott’s puffy tumor can lead to complications like:

• Brain bleed.
• Cavernous sinus thrombosis.
• Dural venous sinus thrombosis (blood clots in your brain’s major vessels).
• Ischemia.
• Meningitis.
• Orbital cellulitis.
• Sepsis.
• Thrombosis.

Pott’s puffy tumor can be fatal. It’s important to seek medical care as soon as you realize something isn’t right.

How is Pott’s puffy tumor diagnosed?

An otolaryngologist (ENT) usually diagnoses Pott’s puffy tumor with a:

• CT scan (computed tomography scan).
• Nasal endoscopy.
• Physical examination.

These tests can help your healthcare provider rule out other conditions that share similar symptoms.

Conditions with overlapping symptoms

Sometimes, one condition shares symptoms with several other disorders. When this happens, providers must run tests to figure out which condition you have. They call this process differential diagnosis.

Health conditions that share similar symptoms with Pott’s puffy tumor include:

• Acute or chronic sinusitis.
• Cephalohematoma.
• Encephalitis.
• Inflammation from head trauma.
• Non-Hodgkin lymphoma.
• Skin or soft tissue infections.
• Tumors (cancerous or noncancerous).

How is Pott’s puffy tumor treated?

Pott’s puffy tumor treatment usually involves surgery to drain the infection and four to six weeks of broad-spectrum IV (intravenous) antibiotics to keep it from coming back. (Broad-spectrum antibiotics target many different types of bacteria.)

Surgeons typically try minimally invasive surgery first. Then, if necessary, they may do additional procedures.

Possible surgical treatments for Pott’s puffy tumor include:

• Functional endoscopic sinus surgery. Surgeons may use this procedure to widen your sinus drainage pathways so more infection and mucus can drain out. This is the least invasive treatment option, and it doesn’t require incisions. Rather, your surgeon will use a nasal endoscope to do the surgery.
• Craniotomy. In some cases, a surgeon may need to remove a small piece of your skull to access your brain. Once they drain the infection, they’ll replace the piece of your skull.
• Trephination. This surgery involves creating a small hole in your skull to relieve pressure around your brain.
• Frontal sinus obliteration. During this procedure, a surgeon removes your frontal sinuses to reduce the risk of chronic infection.

Can Pott’s puffy tumor be prevented?

You can’t always prevent Pott’s puffy tumor. But here are some things that may reduce your risk:

• Keep an eye on sinusitis symptoms. If you have frequent sinus infections with headaches, fever, thick nasal discharge or forehead swelling, seek immediate medical care.
• Protect yourself from insect bites. Because some cases of Pott’s puffy tumor come from insect bites, you should use insect repellant whenever you go outdoors.
• Visit your dentist regularly. Some oral infections can result in Pott’s puffy tumor. Regular dental cleanings and exams can lessen this risk.
• Wash your hands frequently. This can help minimize your overall risk for infections.
• Wear protective gear when playing contact sports. Wearing an appropriate helmet that fits well can help reduce trauma-related cases of Pott’s puffy tumor.

What’s the outlook for Pott’s puffy tumor?

Your outlook directly corresponds to how quickly you begin treatment. The longer you wait, the higher your risk for dangerous complications.

With prompt treatment, the outlook for Pott’s puffy tumor is usually good. But you must seek immediate medical care as soon as you notice symptoms — particularly, forehead swelling. About 12% of teens with Pott’s puffy tumor die due to complications like sepsis, ischemia, thrombosis and increased pressure in the skull. Early intervention can reduce this risk.

When should I see my healthcare provider?

Tell your provider if you have a sinus infection that doesn’t go away or comes back frequently. Also, if you develop additional symptoms like thick nasal discharge, headaches or — most importantly — a telltale forehead lump, seek immediate treatment or head to the nearest emergency room.

A note from Cleveland Clinic

Waking up with a lump on your forehead (or seeing one on your child’s forehead) can send you into a panic. If something doesn’t look or feel right to you, trust your gut. Seek medical care right away. Waiting too long to start treatment can lead to life-threatening complications. But antibiotics and surgery can get rid of the infection and give you the best chance of a successful recovery.