Pott's puffy tumor and epidural abscess arising from dental sepsis: A casereport

Objective: To present an unusual case of two uncommon cranial complications of frontal sinusitis: Pott's puffy tumor and epidural abscess arising from frontal sinusitis of dental origin, and also two systemic complications of sinusitis: septicemia and empyema, all occurring in an immunocompetent pat ient. Study Design: A 21-year-old man presented with a scalp swelling and e pidural abscess. Magnetic resonance imaging and computed tomographic scans revealed unilateral opacification of the frontal sinus and an epidural absc ess with a direct connection to the scalp abscess. Further history revealed that his symptoms occurred coincidentally with a tooth extraction 2 months before, and he was hospitalized soon after the tooth extraction for sepsis and a lung abscess. Methods: A combined neurosurgical and otolaryngologic approach was required to treat the sinusitis and the associated epidural an d scalp abscess. Results: Cultures returned as Streptococcus intermedius fr om all three sites. The patient was free of disease at the 3-month follow-u p. Conclusions: Odontogenic maxillary sinusitis is well documented; however , there is little reported of frontal sinusitis arising from dental disease . The prevalence of sinusitis of dental origin will be reviewed, including the microbiology of this particularly virulent organism that persisted desp ite earlier treatment with ampicillin. Also, the current thoughts on manage ment of these cases will be discussed with particular reference to local th erapy for sinusitis in addition to systemic treatment with antibiotics.