一个76岁的女人,最初认为她的右上眼睑有一个简单的脓肿,提交给我们的整形和重建外科。增强三维面部计算机断层扫描(CT)显示右上眼睑有脓肿,右额窦出现脓肠囊肿,伴有右眼眶上壁的骨侵蚀。根据CT扫描的结果,我们诊断为不典型的Pott's浮肿肿瘤(PPT),上眼睑脓肿源自额窦炎。首先,我们部门进行了手术切开和引流,并放置了经皮真空引流。为了提供更明确的治疗,耳鼻喉科医师随后进行了内窥镜鼻窦手术(ESS)。患者在ESS后5天出院,无任何并发症。在1年的随访中,未观察到复发或明显的神经症状。在我们观察到的案例中,患者表现为上眼睑脓肿和蜂窝织炎,表明可能的轨道参与。对于这样的患者,CT扫描是必要的。鉴于PPT的可能性,进行全面的鉴别诊断是至关重要的,而不是采取直接的脓肿治疗方法.
A 76-year-old woman, initially thought to have a simple abscess on her right upper eyelid, presented to our department of plastic and reconstructive surgery. Enhanced three-dimensional facial computed tomography (CT) revealed an abscess on the right upper lid, with a pyomucocele present in the right frontal sinus, accompanied by bone erosion in the superior wall of the right orbit. Based on the results of the CT scan, we diagnosed an atypical Pott\'s puffy tumor (PPT) with an abscess on the upper lid originating from the frontal sinusitis. First, surgical incision and drainage were performed in our department, and a percutaneous vacuum drain was placed. To provide a more definitive treatment, endoscopic sinus surgery (ESS) was subsequently performed by otorhinolaryngologists. The patient was discharged without any complications 5 days after ESS. At a 1-year follow-up, no recurrence or notable neurological symptoms were observed. In the
case we observed, the patient presented with an upper eyelid abscess and cellulitis, indicating possible orbital involvement. For such patients, a CT scan is necessary. Given the possibility of PPT, it is critical to perform a comprehensive differential diagnosis rather than defaulting to a straightforward approach involving abscess treatment.