Persistent sinusitis can result in extension of the infectious process into the surrounding tissues. Bony destruction, originating from the frontal sinus, can extend anteriorly. This leads to the development of a doughy edematous forehead called Potts puffy tumor. If a frontal bone osteomyelitis extends posteriorly, a frontal brain abscess, meningitis, subdural empyema, or epidural abscess can develop. Extension from the ethmoid sinus can result in orbital or periorbital cellulitis. Finally, direct extension from the paranasal sinus to the venous or lymphatic system can cause cavernous sinus thrombosis. All patients suspected of having any infection extension of infection beyond the paranasal sinuses should undergo immediate CT scanning, intravenous antibiotic therapy, and emergent consultation with the appropriate specialist.

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