Journal of Clinical Images and Medical Case Reports

ISSN 2766-7820
Clinical Image - Open Access, Volume 4

Frontal swelling of the forehead in a teenager

Carolina Oliveira Gonçalves1*; Francisca Galhardo Saraiva1; Marta Gião2; Paula Correia1

1Pediatrics Service, Child and Youth Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal.

2Ear, Nose and Throat Service, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal.

*Corresponding Author : Carolina O Gonçalves
Pediatrics Service, Child and Youth Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal.
Email: [email protected]

Received : May 04, 2023

Accepted : May 29, 2023

Published : Jun 05, 2023

Archived :

Copyright : © Gonçalves CO (2023).

Keywords: Pott’s puffy tumor; Frontal sinusitis; Osteomyelitis.

Abbreviations: CT: Computed Tomography; ETN: Ear, Nose and Throat.

Citation: Gonçalves CO, Saraiva FG, Gião M, Correia P. Frontal swelling of the forehead in a teenager. J Clin Images Med Case Rep. 2023; 4(6): 2441.

Case description

A 16-year-old male was admitted to the pediatric emergency department with headache, frontal swelling and fever. Physical examination revealed a prominent frontal swelling, painful on palpation. Analytical evaluation showed a rise in inflammatory markers (leukocytes 15100 cells/μL, 84.3% neutrophils and C-reactive protein 17.19 mg/dL). Computed Tomography (CT) of the cranium and the paranasal sinuses confirmed pansinusitis, without bone impairment nor intracranial complications. He was treated with ceftriaxone and clindamycin and was daily assessed by ETN. On day 3, preseptal cellulitis was noted. Upon clinical worsening on day 8 (Figures 1 and 2), with no neurological repercussion, a new CT scan was performed and documented osteomyelitis of the frontal bone, associated with subperiosteal abscess (Figure 3). The patient underwent endoscopic sinus surgery and antibiotic coverage was widened, initiating vancomycin. Blood cultures and cultural exam of the surgically drained pus were sterile. After 21 days of antibiotic therapy, he was discharged with favorable evolution.

Pott’s puffy tumor is a subperiostal abscess with osteomyelitis of the frontal bone [1,2]. Since the advent of modern antibiotic therapy, it is a rare complication of frontal sinusitis, but can also occur due to head trauma or surgery [1-3].

There is a higher incidence among teenagers since the frontal sinuses are not completely developed until adolescence and the flow rate of the venous drainage, through the diploic veins, increases during this period [2,4]. Typical presentation includes forehead swelling, headache, fever, purulent rhinorrhea and occasional preseptal cellu-litis. Aggravating symptoms, such as altered mental status, lethargy, vomiting or seizures, should prompt suspi-cion of intracranial involvement [2,4,5].

The rarity of Pott’s puffy tumor may be the cause of delayed diagnosis. However, it is imperative to initiate broad-spectrum antibiotic therapy immediately, followed by surgical intervention to prevent long-term neurologic complications, morbidity and mortality [1-3,5].

Figure 1: Patient showing clinical worsening with reemerging forehead swelling (day 8).

Figure 2: Patient showing clinical worsening with reemerging forehead swelling, profile view (day 8).

Figure 3: Cranial CT, without contrast, sagittal cut, evidencing frontal sinusitis with erosion of the outer table of the right frontal sinus. Note the forehead edema.

Acknowledgement: The authors declare that there were no conflicts of interest and no funding source.


  1. Haider HR, Mayatepek E, Schaper J, Vogel M. Pott’s puffy tumor: A forgotten differential diagnosis of frontal swelling of the forehead. J Pediatr Surg. 2012; 47: 1919-1921.
  2. Koltsidopoulos P, Papageorgiou E, Skoulakis C. Pott’s puffy tumor in children: A review of the litera-ture. Laryngoscope. 2020; 130: 225-231.
  3. Stark P, Ghumman R, Thomas A, Sawyer SM. Forehead swelling in a teenage boy. J Paediatr Child Health. 2015; 51: 731-733.
  4. Ketenci I, Ünlü Y, Tucer B, Vural A. The Pott’s puffy tumor: A dangerous sign for intracranial compli-cations. Eur Arch Otorhinolaryngol. 2011; 268: 1755-1763.
  5. Costa L, Mendes Leal L, Vales F, Santos M. Pott’s puffy tumor: Rare complication of sinusitis. Braz J Otorhinolaryngol. 2020; 86: 812-814.