Pott's puffy tumor: as a very rare and unpredicted complication of ipsilateral pan sinusitis-case presentation and review of articles*

Pott's puffy tumor is considered as a rare clinical entity. It is developed as a rare complication of frontal sinusitis. In addition, the trauma to the frontal area is another suggested cause. The Pott's puffy tumor is presented as a forehead swelling due to sub-periosteal collection. Although, the Pott's puffy tumor is a rare condition but at the same time, it can be serious because it may lead to life threatening complications namely, extradural abscess, subdural abscess, meningitis, encephalitis, and brain abscess. Thus, the Pott's puffy tumor is classified as a very significant surgical emergency.


Discussion and review of literature
Pott's puffy tumor is a name describing a lesion in form of forehead swelling. Percival Pott first described this lesion on 1760.
Although CT scans have a higher radiation dose, at most centers like ours, MRI scanners are not available around the clock. Particular attention should be paid to decrease the radiation dose by strictly following the pediatric protocols for radiation dose reduction. A CT scan with contrast can be performed if there is a high suspicion of intracranial extension. Intracranial complications with or without direct erosion of the frontal bone have been observed in about 60% to 85% of these patients (13)(14)(15) . Tsai et al. reported a 100% rate of intracranial complications in their six pediatric patients with Pott puffy tumor (10) . Ketenci et al. indicated that intracranial complications are often present during a regimen of antibiotics and are often asymptomatic when the abscess is localized in a silent area of the central nervous system (7) .

Conclusion
Early diagnosis and treatment of Pott puffy tumor is necessary. Broad-spectrum antibiotics for 4 to 6 weeks, along with surgical drainage, is the standard of care. This patient underwent functional endoscopic sinus surgery in addition to 4 weeks of antibiotics. Follow-up MRI showed complete resolution.

Authorship contribution
KMB designed the concept, was the main surgeon, wrote and revised the manuscript.ZAH and IMI are the senior registrars, received the patient at the OPD, prepared the patient for the surgery, performed postoperative care and follow up, and collected the patient's data.

Acknowledgments
Not applicable.

Funding
There was no funding for this report.

Ethics approval and consent to participate
The patient gave consent for publication to KMB

Availability of data and materials
Not applicable