724 - Multidisciplinary rehabilitation approach for adult-onset Pott’s puffy tumor with cerebrospinal fluid leak.

Case Diagnosis: Pott’s puffy Tumor with cerebrospinal fluid leak: A case treated with multiple maxillofacial surgeries that emphasizes the importance of rehabilitation in patients with nasal precautions.

Case Description: A 70-year-old female presented with progressive frontal headaches associated with right supraorbital swelling that had begun ten days earlier. A contrast-enhanced CT scan of the sinuses revealed frontal sinusitis, osteomyelitis, frontal sinus erosion, and periorbital abscess consistent with Pott’s puffy tumor. Surgical intervention included bilateral maxillary antrostomy, partial ethmoidectomy, left frontal sinusotomy, and repair of cerebrospinal fluid leak from the right cribriform plate region with a free mucosal graft. Treatment course included long term intravenous antibiotics and acetazolamide for a cerebrospinal fluid leak. The patient was transferred to inpatient rehabilitation and course was complicated with acute left ankle gout flare. Challenges included maintaining nasal precautions despite gout pain creating antalgic gait. Rehabilitation assessments demonstrated functional impairments in transfers, bed mobility, toileting and lower extremity dressing.

Discussions: Pott’s puffy tumor is characterized by localized forehead edema resulting from osteomyelitis of the frontal bone associated with subperiosteal abscess. It is most prevalent in the pediatric population, and it is a rare complication of sinusitis; our patient experienced chronic frontal sinusitis which propagated a septic emboli and lead to intracranial involvement. Her successful outcome was attributed to a multidisciplinary rehabilitation program with specific emphasis on maintaining nasal precautions. Lower body dressing and toileting were challenging given nasal precautions, improved from maximal assistance to modified independent with the aid of a dressing stick, reacher/grabber and sock aid.

Conclusions: This case of adult-onset Pott’s puffy tumor underscores the importance of an aggressive, yet mindful, multidisciplinary rehabilitation approach in patients with head and neck pathologies. It highlights the nuanced challenges of maintaining nasal precautions and can ultimately yield positive functional outcomes.