<prompt> Potts puffy tumor isSub periosteal abscess of frontal boneSub periosteal abscess of ethmoid boneMucocele of frontal boneMucocele of ethmoid bone  <response>: POTTS PUFFY TUMOUR It is formation of diffuse external swelling in the scalp due to subperiosteal pus formation abscess and scalp oedema. x It originates commonly in frontal region and may extend into other regions. x There is acute osteomyelitis of frontal bone. Causes x Chronic frontal sinusitis which eventually suppurates and extends into subperiosteal region. x Trauma--subperiosteal haematoma. x Chronic suppurative otitis media. Features x Pain and boggy swelling in frontal region which is warm, tender. x Toxicity and drowsiness. x Pitting scalp oedema is typical. x Investigations: Total leucocyte count--increased. ESR--raised. X-ray skull. CT scan. x Differential diagnosis: Secondaries in the skull or brain. Complications Osteomyelitis of frontal bone. Spread of infection into intracranial cavity leads to intracranial abscess Extradural or subdural abscess dumb-bell abscess. So may present with features of raised intracranial tension like headache, coning and convulsions. Potts Puffy tumor can be associated with coical vein throm- bosis, epidural brain abscesssubdural empyema. The cause of vein thrombosis is explained by diplopic veins in frontal bone, which communicates with the dural venous plexus; septic thrombi can potentially evolve from foci within the frontal sinus and propagate through this venous system. Treatment x Antibiotics and drainage under general anaesthesia before it spreads into cranial cavity. x Once it extends into cranial cavity, it is treated accordingly by formal neurosurgical decompression often using Dandys brain cannula. x Osteomyelitis of skull bones requires radical removal with recon- struction of skull defect. Ref: SRB manual of surgery 5th edition Pgno: 48 