1
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Amirtharajah M, Olaleye M, Oluyide B, Lenglet A, Ariti C, Farley E, Winters R, Taiwo AO, Shaye DA. Prospective Outcomes of Noma Facial Reconstructive Surgery in Sokoto, Nigeria. Facial Plast Surg Aesthet Med 2024; 26:488-496. [PMID: 38502845 DOI: 10.1089/fpsam.2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background: Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations. Objective: To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria. Methods: Objective outcomes were recorded using the noma-specific NOITULP (nose, outer cheek, inner cheek, trismus, upper/lower lip, particularities) classification system. PROs were recorded using a locally developed tool. Postsurgical changes were assessed by Wilcoxon signed-rank testing. Linear regression was used to look for associated risk factors. The inter-rater reliability (IRR) of the NOITULP score was assessed using the weighted kappa statistic. Results: Forty-nine patients (median age 25 years, 71% male) underwent local/regional flap reconstruction and/or trismus release. Twelve complications were reported. Univariate analysis showed a 3.20 change in PRO score (95% confidence interval 0.59 to 5.81, p = 0.018) per kilogram the patient underwent at time of surgery. The NOITULP score improved from a presurgery median of 3.5 to 2.3 (p < 0.0001), however, the IRR was poor (kappa = 0.0894, p < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 (p < 0.0001). Conclusions: Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria. Clinical Trial Registration: OCA017-63.
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Affiliation(s)
| | - Michael Olaleye
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
| | | | - Annick Lenglet
- International Centre for Antimicrobial Resistance Solutions, Copenhagen, Denmark
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elise Farley
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
| | - Ryan Winters
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital and New South Wales, New Lambton Heights, New South Wales, Australia
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Abdurrazaq Olanrewaju Taiwo
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - David A Shaye
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
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2
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Gebretsadik HG. Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia. Laryngoscope Investig Otolaryngol 2024; 9:e1250. [PMID: 38651077 PMCID: PMC11034487 DOI: 10.1002/lio2.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/18/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Noma, an overlooked infectious disease, inflicts severe facial tissue damage, posing substantial challenges in patient care. This study delves into surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia. Materials and Methods The research employed a cross-sectional retrospective review of medical records treated between 2007 and 2019 retrieved from the Facing Africa database. Results The review encompasses 235 noma cases. Twenty-four cases (19 females and 5 males) experienced various complications, predominately major complications leading to subsequent revision surgeries. The identified complications included flap necrosis, abscess formation, tenderness, graft site infection, flap bulking, dental misalignment, corner of the mouth dehiscence, infected bone and plate, flap malpositioning, restricted mouth opening with ankylosis, neuropathic pain, recurrent flap infection, and offensive odor. Revision surgeries included wound cleansing, abscess drainage, skin graft removal, exploratory surgery, wound care, debulking, scar removal, debridement, trismus release, commisuroplasty, and flap repositioning. Conclusion These findings illuminate the intricacies of noma surgery in Ethiopia, emphasizing the importance of understanding the nature and frequency of complications for optimizing treatment outcomes. Insights from this study can guide healthcare providers, especially novice surgeons, and policymakers, in refining surgical interventions and enhancing outcomes for noma patients. Improved knowledge in this realm is crucial for advancing patient care and developing targeted interventions. Level of Evidence 5.
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Oluwalomola OV, Briskin E, Olaleye M, Samuel J, Oluyide B, Sherlock M, Adetunji AS, Amirtharajah M. Physiotherapy and associated factors affecting mouth opening changes in noma patients during initial hospitalization at an MSF-supported hospital in Northwest Nigeria-A retrospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001995. [PMID: 37656669 PMCID: PMC10473475 DOI: 10.1371/journal.pgph.0001995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/24/2023] [Indexed: 09/03/2023]
Abstract
Noma is a rapidly progressing infection of the oral cavity, which can cause the disintegration of the cheek, nose and eye, in under a week. One of the most disabling sequelae is trismus, the restriction of mouth opening, which results in difficulties in speech, mastication, social feeding habits and maintenance of oral hygiene. Restriction of mouth opening among noma patients mostly begins during the transition between World Health Organisation (WHO) stage 3 (gangrene) and stage 4 (scarring) of the disease. This study aims to describe the impact of physiotherapy in noma patients hospitalised with stages 3 and 4 of the disease and to identify factors that influence change in mouth opening of noma patients. This study is a retrospective analysis of routinely collected data from patients admitted at Noma Children Hospital, Sokoto, Northwest Nigeria between 1 May 2018 and 1 May 2020. Eligible patients included stage 3 and 4 noma patients who had not undergone any surgical reconstruction or trismus release surgery but received physiotherapy assessment and treatment during initial hospitalization. Factors associated with a change in mouth opening were identified using paired t-test analysis, bivariate and multivariate analyses. The mean difference in the mouth opening from admission to discharge was 6.9mm (95% CI: 5.4 to 8.3, p < 0.0001). Increased number of physiotherapy sessions and patient age above three years were significant predictors of improvement in mouth opening (p-value 0.011, 0.001 respectively). Physiotherapy treatment received within an adequate number of physiotherapy sessions for stage 3 and 4 noma patients during the period of the first hospitalization is important and results in a significant increase in mouth opening. Hence, noma patients at these stages should routinely undergo physiotherapy as part of a holistic approach to treatment.
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Affiliation(s)
| | - Emily Briskin
- Medecins Sans Frontieres, Sokoto, Nigeria
- Medecins Sans Frontieres, Epicentre, Paris, France
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4
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Farley E, Amirtharajah M, Shaye DA. Noma, a neglected disease: prevention is better than cure. Curr Opin Otolaryngol Head Neck Surg 2022; 30:219-225. [PMID: 35906973 DOI: 10.1097/moo.0000000000000819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There is a need for concerted effort to increase Global awareness about noma (cancrum oris). This paper aims to summarize the recent literature on noma and provide suggestions that could be implemented to raise awareness about this neglected disease. RECENT FINDINGS Noma has been recognized, diagnosed and reported for centuries. Despite significant progress in scientific methods over time, the published literature on noma has predominantly been of low level clinical and scientific evidence. Recent studies have reported on noma's global distribution and its predisposing risk factors, its treatment, its knowledge and beliefs and has included a number of literature reviews. Noma cases are being reported from an increasingly diverse set of geographical locations. SUMMARY Noma has largely been neglected in the research sphere. Noma is a preventable disease and its progression can be halted if patients are recognized and treated in the early stages of disease. Treatment for late stage noma survivors remains complex and time consuming, requiring substantial human and financial resources most commonly not achieving functional and cosmetic anatomy. The ultimate aim is therefore prevention, initiatives should be integrated into existing health programs.
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Affiliation(s)
- Elise Farley
- Nudibrink Research Consultancy, Cape Town, South Africa
- Centre for Applied Human Rights, University of York, York, United Kingdom
| | | | - David A Shaye
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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5
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Farley E, Mehta U, Srour ML, Lenglet A. Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021). PLoS Negl Trop Dis 2021; 15:e0009844. [PMID: 34905547 PMCID: PMC8670680 DOI: 10.1371/journal.pntd.0009844] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Noma (cancrum oris) is an ancient but neglected and poorly understood preventable disease, afflicting the most disenfranchised populations in the world. It is a devastating and often fatal condition that requires urgent and intensive clinical and surgical care, often difficult to access as most cases of noma occur in resource-limited settings. We conducted a scoping review of the literature published on noma to understand the size and scope of available research on the disease and identify research gaps that need to be addressed to evolve our understanding of how to address this disease. Methods We searched 11 databases and collected primary peer reviewed articles on noma in all languages, the final search was conducted on 24th August 2021. The oldest manuscript identified was from 28th March 1843 and the most recently published manuscript was from 3rd June 2021. Search terms included cancrum oris and noma. Data was extracted using a standardised data extraction tool and key areas of interest were identified. The Preferred Reporting Items for Systemic review and Meta-Analyses requirements were followed. Results The review included 147 articles, the majority of the studies (n = 94, 64%) were case reports. Most manuscripts (n = 81, 55%) were published in the 2000s, 49 (33%) were from the 1900s and 17 (12%) from the 1800s. The main areas of interest identified were the history and epidemiology of the disease, noma’s clinical progression and aetiology, treatment regimens, mortality rates and the risk factors for the development of noma. Conclusions Noma has been reported in the literature for hundreds of years; however important gaps in our understanding of the disease remain. Future research should focus on determining the burden and distribution of disease; the true mortality rate, pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment. Noma is a devastating and often fatal condition that mainly affects children in severely disenfranchised communities. Noma is preventable and requires urgent basic medical care in the early stages of disease. Once the disease reaches the last stage, sequelae, survivors require expert surgical care, usually difficult to access as most cases of noma occur in resource-limited settings. We conducted a scoping review of the literature published on noma to understand the size and scope of available research on the disease and to identify research priorities that will evolve our understanding of how to eradicate this disease. Our review showed that noma has been reported in the literature for hundreds of years; however several major gaps in knowledge still exist. There is appreciation among the small community of clinicians and researchers involved in noma care and research that these gaps in knowledge impact on the ability to develop and implement sound evidence-based policies and activities aimed at eradicating noma from communities that continue to be afflicted by this ancient disease. The main focus of future research should be to study the burden and distribution of disease; the true mortality rate, and the pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment.
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Affiliation(s)
- Elise Farley
- Noma Children’s Hospital, Médecins Sans Frontières, Sokoto, Nigeria
- Nudibrink Research Consultancy, Cape Town, South Africa
- * E-mail:
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, Western Cape, South Africa
| | | | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
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6
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Kumar S, Charllu AP. Extraarticular joint ankylosis: a rare presentation. BMJ Case Rep 2021; 14:e244616. [PMID: 34844960 PMCID: PMC8634213 DOI: 10.1136/bcr-2021-244616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/03/2022] Open
Abstract
Pseudoankylosis is a rare condition that causes inability to open the mouth due to condition related to outside of the temporomandibular joint. Most literature refers to this hypomobility disorder, a result of fusion of the zygomatic bone to the coronoid process, and very rarely is insidious coronoid hyperplasia causing mechanical interference with the posterior maxilla has been reported. We present a case of a 45-year-old woman, who presented with coronoid malformation and overgrowth resulting in progressive decrease in mouth opening. She was managed with coronoidectomy, following which good mouth opening was obtained. In this paper we discuss about the diagnosis and management of this rare disorder.
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Affiliation(s)
- Saurabh Kumar
- Dental and Oral Surgery Unit-1, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arun Paul Charllu
- Dental Surgery Unit 1, Christian Medical College, Vellore, Tamil Nadu, India
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7
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Speiser S, Langridge B, Birkl MM, Kubiena H, Rodgers W. Update on Noma: systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease. BMJ Open 2021; 11:e046303. [PMID: 34353795 PMCID: PMC8344268 DOI: 10.1136/bmjopen-2020-046303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Noma is a significant yet neglected disease which affects some of the least developed countries in the world. The long-term benefit and safety of Noma surgical reconstructive missions have recently been under scrutiny due to a perceived lack of measurable outcomes and appropriate follow-up. This study analyses and reports on classifications, outcome measurement tools and follow-up for reconstructive surgery after Noma disease. METHODS This systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The three medical databases Medline, EMBASE and Web of Sciences were searched, articles published between 1 January 1983 and 15 April 2020 were included. All primary evidence on reconstructive surgery following Noma disease, reporting data on outcome after surgery, follow-up time and complications were included. Extracted data were aggregated to generate overall and population corrected mean outcomes and complication rates. RESULTS Out of 1393 identified records, 31 studies including 1110 Noma patients were analysed. NOITULP and Montandon/WHO were the most commonly used classification systems. Mouth opening (MO) and complication rates were the two most often reported outcomes. Overall mean complication rate was 44%, reported by 24 studies. Postoperative MO was reported by eight publications, of which, five reported long-term outcomes (>12 months). Mean MO improved by 20 mm when compared with mean population weighted preoperative MO (7 mm). At long-term follow-up, MO decreased to 20 mm. CONCLUSIONS Studies reporting on neglected diseases in developing countries often lack methodological rigour. Surgeons should be mindful during patient examination by using a classification system that allows to compare preoperative versus postoperative state of disease. Short-term mission surgery is a vital part of healthcare delivery to underdeveloped and poor regions. Future missions should aim at sustainable partnerships with local healthcare providers to ensure postoperative care and long-term patient-oriented follow-up. A shift towards a diagonal treatment delivery approach, whereby local surgeons and healthcare staff are educated and empowered, should be actively promoted. PROSPERO REGISTRATION NUMBER CRD42020181931.
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Affiliation(s)
- Sophie Speiser
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Benjamin Langridge
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Moira Melina Birkl
- Karl Landsteiner University of Health Sciences, Krems, Niederosterreich, Austria
| | | | - Will Rodgers
- Department of Dental and Maxillofacial Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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8
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Isah S, Amirtharajah M, Farley E, Semiyu Adetunji A, Samuel J, Oluyide B, Bil K, Shoaib M, Abubakar N, de Jong A, Pereboom M, Lenglet A, Sherlock M. Model of care, Noma Children's Hospital, northwest Nigeria. Trop Med Int Health 2021; 26:1088-1097. [PMID: 34080264 PMCID: PMC9292046 DOI: 10.1111/tmi.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Nigerian Ministry of Health has been offering care for noma patients for many years at the Noma Children’s Hospital (NCH) in Sokoto, northwest Nigeria, and Médecins Sans Frontières has supported these initiatives since 2014. The comprehensive model of care consists of four main components: acute care, care for noma sequelae, integrated hospital‐based services and community‐based services. The model of care is based on the limited evidence available for prevention and treatment of noma and follows WHO’s protocols for acute patients and best practice guidelines for the surgical treatment of noma survivors. The model is updated continually as new evidence becomes available, including evidence generated through the operational research studies performed at NCH. By describing the model of care, we wish to share the lessons learned with other actors working in the noma and neglected tropical disease sphere in the hope of guiding programme development.
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Affiliation(s)
| | | | - Elise Farley
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | - Joseph Samuel
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | - Karla Bil
- Médecins Sans Frontières, Amsterdam, Netherlands
| | | | - Nura Abubakar
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | | | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, Netherlands.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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9
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Farley ES, Amirtharajah M, Winters RD, Taiwo AO, Oyemakinde MJ, Fotso A, Torhee LA, Mehta UC, Bil KA, Lenglet AD. Outcomes at 18 mo of 37 noma (cancrum oris) cases surgically treated at the Noma Children's Hospital, Sokoto, Nigeria. Trans R Soc Trop Med Hyg 2021; 114:812-819. [PMID: 32785671 PMCID: PMC7645286 DOI: 10.1093/trstmh/traa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/17/2020] [Accepted: 07/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background Noma is a rapidly progressing infection of the oral cavity frequently resulting in severe facial disfigurement. We present a case series of noma patients surgically treated in northwest Nigeria. Methods A retrospective analysis of routinely collected data (demographics, diagnosis and surgical procedures undergone) and in-person follow-up assessments (anthropometry, mouth opening and quality of life measurements) were conducted with patients who had surgery >6 mo prior to data collection. Results Of the 37 patients included, 21 (56.8%) were male and 22 (62.9%) were aged >6 y. The median number of months between last surgery and follow-up was 18 (IQR 13, 25) mo. At admission, the most severely affected anatomical area was the outer cheek (n = 9; 36.0% of patients had lost between 26% and 50%). The most frequent surgical procedures were the deltopectoral flap (n = 16; 43.2%) and trismus release (n = 12; 32.4%). For the eight trismus-release patients where mouth opening was documented at admission, all had a mouth opening of 0–20 mm at follow-up. All patients reported that the surgery had improved their quality of life. Conclusions Following their last surgical intervention, noma patients do experience some improvements in their quality of life, but debilitating long-term sequelae persist.
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Affiliation(s)
- Elise S Farley
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria.,Department of Public Health Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | | | - Ryan D Winters
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, LA, USA
| | - Abdurrazaq O Taiwo
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.,Faculty of Dental Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | | | - Linda A Torhee
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
| | - Ushma C Mehta
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Karla A Bil
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Annick D Lenglet
- Médecins Sans Frontières, Amsterdam, the Netherlands.,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
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10
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Panagatla P, Ravula P, Praveen S, Varagani NR, Srikanth R, Appaka JK. Anterolateral Thigh Skin and Fascia in Facial Skin Defects with Trismus: Two Problems, One Solution. Indian J Plast Surg 2021; 54:192-196. [PMID: 34239243 PMCID: PMC8257313 DOI: 10.1055/s-0041-1729504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A case series of five patients with skin loss in the lateral face with trismus that followed delayed presentation following trauma, necrotizing infection, and radiation fibrosis was treated with coronoidectomy and condylar excision to effect adequate mouth opening; the anterolateral thigh flap was used for cover and the fascia was used as an interposition graft to prevent recurrence. Two patients with more than 9 years of follow-up had an average of 40 mm interincisal opening.
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Affiliation(s)
- Prakash Panagatla
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Parvathi Ravula
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - S Praveen
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - R Srikanth
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jagadish Kiran Appaka
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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11
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Honeyman C, Patel V, Yonis E, Fell M, Demissie Y, Eshete M, Martin D, McGurk M. Long-term outcomes associated with short-term surgical missions treating complex head and neck disfigurement in Ethiopia: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2020; 73:951-958. [DOI: 10.1016/j.bjps.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/26/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
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12
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Rickart AJ, Rodgers W, Mizen K, Merrick G, Wilson P, Nishikawa H, Dunaway DJ. Facing Africa: Describing Noma in Ethiopia. Am J Trop Med Hyg 2020; 103:613-618. [PMID: 32372746 DOI: 10.4269/ajtmh.20-0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Noma affects the most marginalized communities in the world, beginning as oral ulceration and rapidly progressing to orofacial gangrene. With a mortality rate estimated to be as high as 90% and with very few able to access treatment in its active phase, very little is understood about the disease. This retrospective review of patients treated by Facing Africa for deformity and functional impairment secondary to noma between May 2015 and 2019 highlights some of the difficulties encountered by those afflicted. Eighty new patients with historical noma defects were identified and were seen over the course of nine surgical missions, with notes providing valuable geographical, socioeconomic, and psychosocial information. The mean self-reported age of onset was 5 years and 8 months, with a median time of 18 years from onset to accessing treatment. Before intervention, 65% covered their face in public, 59% reported difficulty eating, 81% were unhappy with their appearance, and 71% experienced bullying. We aimed at emphasizing the significant burden, both psychologically and physically of noma, demonstrating the disparity between recent decades of progress in the well-being of Ethiopians in general and the access to health care and mental health support for some of those most in need.
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Affiliation(s)
- Alexander J Rickart
- Department of Oral and Maxillofacial Surgery, Great Ormond Street NHS Foundation Trust, London, United Kingdom
| | - Will Rodgers
- Department of Oral and Maxillofacial Surgery, Barts Health NHS Trust, London, United Kingdom
| | - Kelvin Mizen
- Department of Oral and Maxillofacial Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Graham Merrick
- Department of Oral and Maxillofacial Surgery, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Paul Wilson
- Department of Plastic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hiroshi Nishikawa
- Department of Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - David J Dunaway
- Department of Plastic Surgery, Great Ormond Street NHS Foundation Trust, London, United Kingdom
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13
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Farley E, Oyemakinde MJ, Schuurmans J, Ariti C, Saleh F, Uzoigwe G, Bil K, Oluyide B, Fotso A, Amirtharajah M, Vyncke J, Brechard R, Adetunji AS, Ritmeijer K, van der Kam S, Baratti-Mayer D, Mehta U, Isah S, Ihekweazu C, Lenglet A. The prevalence of noma in northwest Nigeria. BMJ Glob Health 2020; 5:e002141. [PMID: 32377404 PMCID: PMC7199707 DOI: 10.1136/bmjgh-2019-002141] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Noma, a rapidly progressing infection of the oral cavity, mainly affects children. The true burden is unknown. This study reports estimated noma prevalence in children in northwest Nigeria. Methods Oral screening was performed on all ≤15 year olds, with caretaker consent, in selected households during this cross-sectional survey. Noma stages were classified using WHO criteria and caretakers answered survey questions. The prevalence of noma was estimated stratified by age group (0–5 and 6–15 years). Factors associated with noma were estimated using logistic regression. Results A total of 177 clusters, 3499 households and 7122 children were included. In this sample, 4239 (59.8%) were 0–5 years and 3692 (52.1%) were female. Simple gingivitis was identified in 3.1% (n=181; 95% CI 2.6 to 3.8), acute necrotising gingivitis in 0.1% (n=10; CI 0.1 to 0.3) and oedema in 0.05% (n=3; CI 0.02 to 0.2). No cases of late-stage noma were detected. Multivariable analysis in the group aged 0–5 years showed having a well as the drinking water source (adjusted odds ratio (aOR) 2.1; CI 1.2 to 3.6) and being aged 3–5 years (aOR 3.9; CI 2.1 to 7.8) was associated with being a noma case. In 6–15 year olds, being male (aOR 1.5; CI 1.0 to 2.2) was associated with being a noma case and preparing pap once or more per week (aOR 0.4; CI 0.2 to 0.8) was associated with not having noma. We estimated that 129120 (CI 105294 to 1 52 947) individuals <15 years of age would have any stage of noma at the time of the survey within the two states. Most of these cases (93%; n=120 082) would be children with simple gingivitis. Conclusions Our study identified a high prevalence of children at risk of developing advanced noma. This disease is important but neglected and therefore merits inclusion in the WHO neglected tropical diseases list.
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Affiliation(s)
- Elise Farley
- Noma Children's Hospital, Médecins Sans Frontières, Sokoto, Nigeria.,Department of Public Health Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | | | | | - Cono Ariti
- Centre for Trials Research, Cardiff University School of Medicine, Cardiff, UK
| | - Fatima Saleh
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Gloria Uzoigwe
- Department of Dentistry, Nigerian Ministry of Health, Abuja, Nigeria
| | - Karla Bil
- Operational Center Amsterdam Headquarters, Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Bukola Oluyide
- Nigeria Mission, Médecins Sans Frontières, Abuja, Nigeria
| | - Adolphe Fotso
- Nigeria Mission, Médecins Sans Frontières, Abuja, Nigeria
| | - Mohana Amirtharajah
- Operational Center Amsterdam Headquarters, Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | | | | | - Koert Ritmeijer
- Operational Center Amsterdam Headquarters, Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Saskia van der Kam
- Operational Center Amsterdam Headquarters, Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Denise Baratti-Mayer
- Service of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Shafi'u Isah
- Department of Clinical Services, Noma Children's Hospital, Sokoto, Nigeria
| | - Chikwe Ihekweazu
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Annick Lenglet
- Operational Center Amsterdam Headquarters, Médecins Sans Frontières, Amsterdam, The Netherlands.,Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
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Abstract
Trismus is a frequent complication of healed Noma infection and is caused by soft tissue and muscle contraction. Free-flap surgery is recommended to replace the missing oral mucosa and soft tissue. However, significant complications can occur if this surgery is performed in places like Africa, where conditions are usually less than optimal. In 2007, the authors started to treat patients with trismus in Niamey, Niger by distracting the soft tissue and muscle constriction between the jaws with a bone distractor continuously for 1 month with the aim of achieving a mouth opening of 3 cm. The distraction was limited to 1 mm/d. performed under local anesthesia with some sedation. Minor complications such as infection in the pin holes were easily managed. In 2009, 2 patients with trismus after Noma with a follow-up of 2 years were reported. Till date, the authors have successfully performed trismus release in more than 69 patients in Niamey and Guinea Bissau. The present study analyses the results of distraction therapy in 40 patients with follow-ups until 60 months. At the end of distraction, the mean interincisal distance was 2.7 ± 0.5 cm. Mouth opening 6 months after distraction had not reverted. However, 3 to 5 years after treatment, some signs of relapse were detected, with an average mouth opening of 1.5 ± 1.9 cm. Physiotherapy was unfortunately not feasible. The presented results strongly support the efficacy of distraction therapy to correct trismus in Noma patients.
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15
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Strategy for the Treatment of Zygomatic-Coronoid Ankylosis. J Craniofac Surg 2019; 31:e222-e224. [PMID: 31856134 DOI: 10.1097/scs.0000000000006090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Zygomatic-coronoid ankylosis is a rare complication in maxillofacial trauma. Currently, less of 30 cases reported in the literature. The aim of this study was to report a case of zygomatic-coronoid ankylosis after trauma. A 26-year-old male, with zygomatic-coronoid ankylosis after 7 years of facial trauma, was treated by intraoral bilateral coronoidectomy. However, the literature continues to discuss the best approach, intraorally or extraorally. This study observed that the intraoral approach was easily performed and without complications.
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