Sinusitis

Pott’s Puffy Tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, characterized by subperiosteal abscess formation and frontal bone osteomyelitis. Although predominantly seen in adolescents, adult cases are increasingly recognized. Early diagnosis is essential to prevent severe orbital and intracranial sequelae. We present two patients with distinct clinical features: a 31-year-old female with chronic frontal sinusitis complicated by sequestrated bone extrusion through a cutaneous fistula, and a 16-year-old male with an acute presentation of subperiosteal abscess, nasal polyp-related obstruction of the osteomeatal complex (OMC), and orbital cellulitis. Both patients underwent combined surgical and medical management, including broad-spectrum intravenous antibiotics, functional endoscopic sinus surgery, and external drainage. In the adult, necrotic bone was excised, and the anterior frontal wall was reconstructed with titanium mesh to restore sinus anatomy and drainage, while in the adolescent, early abscess drainage and polyp removal ensured frontal recess patency and prevented osteomyelitis. Postoperative follow-up demonstrated complete resolution without recurrence. These cases highlight that PPT can occur in both acute and chronic settings of chronic rhinosinusitis with nasal polyps, emphasizing the importance of prompt imaging, multidisciplinary evaluation, and individualized surgical strategies to optimize outcomes and minimize life-threatening complications.

Acute rhinosinusitis in children is typically caused by viral or bacterial infections. However, methicillin-resistant Staphylococcus aureus (MRSA) is increasingly linked to recurrence and severe complications, including orbital involvement. We present a case of a 6-year-old boy with periorbital swelling, proptosis, and fever following upper respiratory symptoms. Imaging revealed pansinusitis with a subperiosteal orbital abscess. He was treated empirically with intravenous ceftriaxone and metronidazole, followed by endoscopic sinus surgery. Intraoperative cultures confirmed MRSA, leading to a switch to vancomycin. The patient recovered fully without complications. This case illustrates the clinical challenges posed by MRSA sinusitis and emphasises its public health implications. Integrating antimicrobial stewardship, promoting community hygiene, ensuring early diagnostics and healthcare access, and enhancing epidemiological surveillance can play a pivotal role in reducing the burden of MRSA-related complications in children.

This retrospective study reviews the clinical features, computed tomography (CT) findings, complications and outcomes of horses with skull fractures involving the facial bones. Medical records from the Royal Veterinary College, Hatfield, United Kingdom, and the Universidad Complutense, Madrid, Spain, were reviewed to identify horses presented for head CT with a history of skull fracture involving the facial bones between 2018 and 2022. Thirteen horses were included. Secondary sinusitis was present in 10 of the horses with the rostral maxillary, caudal maxillary and ventral conchal sinuses being the most commonly affected. There was associated fracture of dental structures in three cases. Treatment was conservative in seven cases, while in six horses some minimal surgical intervention was undertaken and included the removal of loose bony fragments and trephination for sinoscopy in two cases, fragment removal and sinus flush through a Foley catheter in three cases and dental extraction in one case. Prognosis was reported to be good to excellent in 10 horses. Among the most common complications, cosmetic sequalae was recorded in three cases. Overall conservative management of skull fracture should be considered a viable option for cases where perfect cosmetic results are not expected and where economics may be a limitation.