Allergy, Nose & Sinus

Pott’s Puffy Tumour – A rare but serious complication of sinusitis! (WARNING – GRAPHIC MEDICAL IMAGES)

February 10, 2020
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Sinusitis (infection of the sinuses) is a common condition, affecting up to 15% of the population. The symptoms can be similar to that of a common cold or flu. In fact, patients with sinusitis visiting Dr Gan would often complain of having “frequent cold/flu” or having “a cold/flu that never really goes away”. As sinuses are close to the eyes and brain, if left untreated, some sinus infections can potentially spread to these major organs. Dr Gan shares his experience of managing a recent patient with sinusitis that resulted in a rare local complication close to the patient’s brain.

 

 

Mr A is a 62 year old man who had a sudden onset of headache in the forehead region and a painful swelling over his forehead which started about a week ago.  He has had intermittent blocked nose and experienced “frequent colds/flu” for many years. On examination, there was a tense, tender swelling over his forehead.

 

 

Potts Puffy Tumour

 

Potts Puffy Tumour 2

A doughy tender swelling on the forehead of the patient which is classical of the appearance of a Pott’s Puffy tumour

 

 

A scope through his nose showed some pus close to his sinuses.

 

 

Light Sinus Drainage

Nasoendoscopic picture of the left nasal cavity showing pus in the middle meatus (drainage area for most sinuses)

 

 

Sinus-Infection-1

Nasoendoscopic picture showing more pus at the back end of the middle meatus

 

 

Nasoendoscopic picture

Nasoendoscopic picture of the back of the nasal cavity showing more pus

 

 

A CT scan (special series of X-rays) of his nose and sinuses showed severe infection in his sinuses.  The infection in his forehead sinuses (known as the frontal sinus) has eroded through his forehead bone resulting in a collection of pus under his forehead skin. Fortunately for him he sought treatment in time before the infection erodes the wall that separates the sinuses from the brain. If this has happened, it could lead to a severe brain infection.

 

 

CT scan side view of the head

A CT scan of the side view of the head & sinuses showing the collection of pus under the forehead skin, a break in the bone of the forehead sinus and hard bone in the drainage pathway of the frontal recess

 

 

Mr A underwent emergency sinus surgery (through the nose) with Dr Gan, combined with an external drainage of the collection of pus on his forehead with his Facial Plastic ENT colleague. As there was hard bone in the drainage pathway of his frontal recess, the bone had to be drilled away. The infected bone and the soft tissue in his forehead were also debrided. Post surgery, Mr A was given 6 weeks of intravenous antibiotics (antibiotics administered into his vein). He was last seen about a month after the surgery, during which he was recovering well.

 

 

Image Guidance System

An Image Guidance System (IGS) picture taken during surgery (with the green cross marking the position of the dissection instrument in the frontal sinus.

 

 

Mr A’s clinical condition is known as Pott’s Puffy tumour. It refers to a severe sinus infection of the forehead sinus (frontal sinus) that has causes infection of the bone and a collection of pus under the forehead skin. Sometimes, the infection may spread backwards, causing a collection of pus in the brain. This is a rare but potentially life-threatening complication of sinusitis, fortunately not commonly encountered in Singapore!

When Should You See An ENT Specialist In Singapore?

  • Any Ear, Nose or Throat symptoms that you are troubled with or concerned of
  • Persistent blocked nose with mouth breathing or snoring

Dr Gan Eng Cern

Dr Gan Eng Cern is a fellowship trained Consultant Ear, Nose & Throat (ENT) Surgeon. He completed his ENT training in Singapore and obtained his subspecialty training in Rhinology and Endoscopic Skull Base Surgery at the world renowned St Paul’s Sinus Centre, University of British Columbia, Vancouver, Canada. He was also a Senior Clinical Lecturer at Yong Loo Lin School of Medicine at the National University of Singapore. Dr Gan was an avid researcher with numerous publications in reputable international ENT journals. He was also an invited speaker and surgical dissection teacher in many ENT conferences and courses.

Awards

  • 2020 – Reader’s Choice Gold Award for Best ENT Specialist
    (Expat Living Singapore)
  • 2016 – Best Educator Award (Eastern Health Alliance)
  • 2016 – “Wow” Award (Patient Compliment)
  • 2014 – Eastern Health Alliance Caring Award – Silver
  • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College
    of Surgeons, Academy of Medicine Singapore for best scientific surgical
    paper)
  • 2012 – Human Manpower Development Award (Ministry of Health,
    Singapore)
  • 2007 – Singhealth Best Doctor Award

Qualifications

  • MBBS - Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
  • MRCS (Edin) - Member of the Royal College of Surgeons Edinburgh, United Kingdom
  • MMed (ORL) - Master of Medicine in ENT (National University of Singapore)
  • FAMS - Fellow of the Academy of Medicine Singapore

Why Choose Dr Gan Eng Cern

1

Reliable & Reputable ENT Expert

Experienced and patient ENT Specialist who has your best interests at heart. We aim to provide you with accessible and specialized care for any ENT condition in a comfortable setting.

2

Friendly & Helpful Clinic Staff

Our friendly staff will assist you to the best of our ability and we are happy to accept most insurance providers and assist with E-filing with relevant insurance providers or Medisave.

3

Advanced ENT Equipment & Fully Equipped Facility

Our ENT Specialist, Dr Gan Eng Cern, will be able to diagnose and offer personalised treatments for your specific ENT condition. You can expect a high level of ENT care in a spacious setting with in-house minor surgical, endoscopy, allergy testing and microscopy services.

4

Financial Options

There are various financial options available for you to ensure that you are able to receive the most optimal treatment and care. Our ENT clinic staff will be able to assist you with your medical insurance claims and work with your chosen healthcare organization to minimize the hassle and paperwork required. In some cases, you may be able to utilise the funds in your Medisave account to defray part of the costs of your treatment. As our clinic is accredited by the Medisave board, we are able to process your claims from your Medisave for certain clinic procedures.

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