Intended for healthcare professionals

Endgames Spot Diagnosis

Complications of rhinosinusitis

BMJ 2016; 352 doi: (Published 26 February 2016) Cite this as: BMJ 2016;352:i795
  1. Stephen L Ball, specialty registrar and Wellcome Trust clinical research fellow1,
  2. Sean Carrie, consultant ear, nose, and throat surgeon1
  1. 1Ear, Nose, and Throat Surgery, Freeman Hospital, Newcastle upon Tyne, UK
  1. Correspondence to: S L Ball s.l.ball{at}

A 65 year old man was initially referred to plastic surgery because of a recurrent abscess on the forehead, and headache. He was subsequently referred to ear, nose, and throat surgery for definitive management of his sinus complication. What is the diagnosis?


A subperiosteal abscess secondary to frontal sinusitis and osteomyelitis (Pott’s puffy tumour) that has spontaneously burst.


Frontal sinusitis with osteomyelitis (Pott’s puffy tumour) may present with headache, swelling, and sometimes a discharging frontal sinus fistula (fig 2). It arises as a complication of frontal sinusitis and can spread intracranially, with complications from erosion of the posterior table, or more likely by septic thrombophlebitis through …

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