Manoukian L T Martin A C, Westcott L T Sally L, Hughey L C D R Scott B
3rd Medical Battalion, 3d Marine Logistics Group, III Marine Expeditionary Force, Unit 38445, FPO, AP 96373-8445, United States.
Department of Emergency Medicine, NMRTC Camp Pendleton, Camp Pendleton, CA 92055, United States.
Mil Med. 2025 Jul 16. doi: 10.1093/milmed/usaf365.
Acute rhinosinusitis is a common diagnosis within the military, resulting in high healthcare utilization. Barotrauma caused by "sinus squeeze" can increase morbidity associated with rhinosinusitis and can lead to complications such as Pott's Puffy Tumor (PPT). Pott's Puffy Tumor is a rare but serious complication of bacterial rhinosinusitis that is typically treated with intravenous antibiotics and surgical drainage. Herein, we present a case of early PPT that occurred following barotrauma from a plane flight. The patient had sequential healthcare visits during which time he developed the classic "doughy" forehead swelling associated with PPT. Computed tomography demonstrated pansinusitis with ostiomeatal unit obstruction and trans-osseus extension of the underlying sinusitis consistent with early PPT. Importantly, no abscess or bony dehiscence had developed. Given his stability and lack of comorbidities, he was discharged on oral antibiotics with 24-hour specialist outpatient follow-up. Oral corticosteroid therapy was subsequently initiated to promote sinus drainage. At ensuing follow-up, the patient reported development of nasal drainage and resolution of his pain and swelling. This case report demonstrates the feasibility of outpatient treatment with oral medication in the setting of early PPT in select patients. This is of particular utility in the military operational setting, where occupational exposure to barotrauma is frequent, and austere scenarios often limit access to parenteral antibiotics or specialty consultation.
急性鼻窦炎是军队中常见的诊断疾病，导致医疗资源利用率较高。“鼻窦挤压”引起的气压伤会增加与鼻窦炎相关的发病率，并可能导致诸如波特氏浮肿性肿瘤（PPT）等并发症。波特氏浮肿性肿瘤是细菌性鼻窦炎一种罕见但严重的并发症，通常采用静脉注射抗生素和手术引流进行治疗。在此，我们报告一例因飞机飞行气压伤后发生的早期波特氏浮肿性肿瘤病例。患者多次就诊，在此期间出现了与波特氏浮肿性肿瘤相关的典型“面团样”前额肿胀。计算机断层扫描显示全鼻窦炎伴窦口鼻道复合体阻塞，以及与早期波特氏浮肿性肿瘤相符的鼻窦骨膜下扩展。重要的是，当时尚未形成脓肿或骨质缺损。鉴于患者情况稳定且无合并症，给他开了口服抗生素后出院，并安排了24小时专科门诊随访。随后开始口服皮质类固醇治疗以促进鼻窦引流。在随后的随访中，患者报告出现了鼻腔分泌物，疼痛和肿胀也已消退。本病例报告证明了在部分早期波特氏浮肿性肿瘤患者中采用口服药物进行门诊治疗的可行性。这在军事行动环境中具有特别的实用价值，因为在这种环境中，职业性暴露于气压伤的情况很常见，而且严峻的形势往往限制了获得胃肠外抗生素或专科会诊的机会。
