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Verma A, Zaheer A, Ahsan A, Anand A, Abu Serhan H, Nazli Khatib M, Syed Zahiruddin Q, Gaidhane AM, Kukreti N, Rustagi S, Satapathy P, Sharma D, Arora M, Kumar Sharma R. Noma in the WHO's list of neglected tropical diseases: A review of its impact on undeveloped and developing tropical regions. Prev Med Rep 2024; 43:102764. [PMID: 38826589 PMCID: PMC11141281 DOI: 10.1016/j.pmedr.2024.102764] [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: 02/29/2024] [Revised: 04/20/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Background Noma is a neglected tropical disease and a global health concern. Objectives To elucidate the epidemiology, management, prevention, and public health implications of Noma. Methods PubMed, Scopus, and Web of Science, supplemented by Google Scholar and World Health Organization databases, were searched using keywords to gather both published and grey literature from 1970 to 2023 in English. Results Approximately 30,000-40,000 cases occur annually, with varying incidences across various African countries, such as Nigeria, Niger, and Chad. Incidence in Nigerian and Ethiopian states range from 0.6 to 3300 and 1.64 to 13.4 per 100,000 population, respectively. Mortality is approximately 8.5% in Niger. Risk factors include malnutrition, immunocompromised status, poor dental hygiene, inadequate sanitation, gingival lesions, low socioeconomic status, chronic and infectious diseases, low birth weight, high parity, diarrhoea, and fever. Diagnosis is primarily made based on clinical signs/symptoms and accordingly staging of disease is done. Stage I, II and II presents with acute necrotizing gingivitis, facial edema with halitosis, and necrotizing stomatitis, respectively. If the patient survives acute stages, the progress to Stage IV and Stage V manifests as trismus, difficulty in deglutition and phonation, and facial disfigurement, with increased severity in last stage. Treatment encompasses antibiotic therapy (amoxicillin, metronidazole, chlorhexidine, ampicillin, gentamicin), surgical interventions, wound management (honey dressing, ketamine), and nutritional support. Prevention strategies include oral hygiene, vaccination, health education, and community-based interventions. Conclusion Noma's recent inclusion in WHO list of neglected tropical diseases is a milestone in recognizing the importance of prevention and early intervention to globally enhance health outcomes.
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Affiliation(s)
- Amogh Verma
- Rama Medical College Hospital and Research Centre, Hapur, India
| | - Amna Zaheer
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Areeba Ahsan
- Foundation University Medical College, Islamabad, Pakistan
| | - Ayush Anand
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health. Datta Meghe Institute of Higher Education, Wardha, India
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602117, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq
| | - Divya Sharma
- Centre of Research Impact and Outcome, Chitkara University, Rajpura, India
| | - Mithhil Arora
- Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, India
| | - Rakesh Kumar Sharma
- Graphic Era Hill University, Dehradun, India
- Graphic Era (Deemed to be University), Dehradun, India
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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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Eleje GU, Okoh EE, Igbodike EP, Akinsolu FT, Nwaokorie FO, Lusher JM, Tantawi ME, Salako AO, Ezechi OC, Foláyan MNO. Prevalence and associated risk factors for noma in Nigerian children: a systematic review and meta-analysis. BMC Oral Health 2024; 24:685. [PMID: 38867180 PMCID: PMC11170919 DOI: 10.1186/s12903-024-04451-y] [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] [Received: 10/07/2023] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES To determine the prevalence, case-fatality rate, and associated risk-factors of Noma in children in Nigeria. METHODS Search was conducted in PubMed, Google Scholar, and Cochrane Library databases. Data were extraction using a double-blind approach. Discrepancies were resolved by a third reviewer. Heterogeneity was evaluated using I2 statistics. Random-effects model was used for the meta-analysis and subgroup analysis was conducted. The study quality was evaluated using standard Critical-Appraisal-Checklist. RESULTS Of the 1652 articles identified, 12 studies that met the inclusion criteria included 871 cases of Noma. Two studies had high-risk of bias and were excluded in the meta-analysis. Pooled prevalence of Noma was 2.95% (95%CI:2.19-3.71; Z = 7.60; p < 0.00001, I2:100.0). Case fatality was reported in one study. Sex-distribution had a male-to-female ratio of 1.1:1. Malnutrition (88.42%, 95%CI:52.84-124.00; I2:100.0), measles (40.60%; 95% CI:31.56-49.65; I2:100.0) and malaria (30.75%; 95% CI:30.06-31.45; I2:100.0) were the most notable associated risk-factors. Prevalence of Noma was non-significantly lower in southern (1.96%,95%CI:1.49-2.44;6 studies) than in northern (4.43%; 95%CI:-0.98-9.83; 4 studies) Nigeria. One study reported the prevalence of Noma in children younger than 5 years. CONCLUSIONS About every 3 in 100 children in Nigeria had Noma and the prevalence was non-significantly higher in northern than southern Nigeria. Malnutrition, measles, and malaria were major associated risk-factors. Case-fatality rate and prevalence based on different age-groups were inconclusive.
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Affiliation(s)
- George Uchenna Eleje
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria.
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Nigeria.
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka (Nnewi Campus), P.M.B. 5001, Nnewi, Anambra State, Nigeria.
| | - Emeka Emmanuel Okoh
- Department of Community Medicine and Primary Healthcare, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Nigeria
| | - Emeka Philip Igbodike
- Department of Obstetrics and Gynaecology, Havana Specialist Hospital, Surulere Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Advanced Minimal Access Surgical Hospital, Kelina Hospital, Victoria Island, Lagos, Nigeria
| | - Folahanmi Tomiwa Akinsolu
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Public Health, Faculty of Medicine, Lead City University, Ibadan, Nigeria
| | - Francisca Obiageri Nwaokorie
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Joanne Marie Lusher
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Provost's Group, Regent's University London, London, UK
| | - Maha El Tantawi
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt
| | - Abideen Olurotimi Salako
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Public Health, Faculty of Medicine, Lead City University, Ibadan, Nigeria
| | - Oliver Chukwujekwu Ezechi
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Public Health, Faculty of Medicine, Lead City University, Ibadan, Nigeria
| | - Morẹ Nikẹ Oluwátóyìn Foláyan
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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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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5
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Gebretsadik HG. Noma is a facial disfiguring childhood disease: Insights from cases of Noma in Ethiopia. Int J Pediatr Otorhinolaryngol 2024; 177:111845. [PMID: 38176115 DOI: 10.1016/j.ijporl.2023.111845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Noma is a neglected infectious disease that causes severe destruction of facial tissues and poses a significant public health threat. The disease reportedly affects individuals with a debilitating health condition. This study aimed to identify the most vulnerable age group affected by Noma disease and assess the severity of tissue damage among Noma cases in Ethiopia. METHODS A cross-sectional study was conducted to determine the age group most susceptible to noma and assess the disease-associated severity of tissue damage. The research objectives were met by scrutinizing electronic medical records of noma cases treated in Addis Ababa, Ethiopia, from 2007 to 2019, obtained from the Facing Africa database. Data collection was carried out using a standardized survey form, while the severity of facial tissue damage was assessed using the NOIPTUS score. RESULTS Among 164 Noma cases with documented data on disease onset, 92.7 % occurred during childhood, with 92.1 % of those cases being children aged ten years and younger. Approximately 11.6 % of all noma cases had mild tissue damage, classified as NOITULP grade 1, while 26.2 % had an intermediate level of tissue damage, classified as NOITULP grade 2. Severe tissue damage (NOITULP grade 3) was present in 37.2 % of cases, while 25 % had very severe tissue damage (NOITULP grade 4). CONCLUSIONS The findings underscore the vulnerability of children, particularly those aged ten years and younger, to Noma disease, supporting the argument that Noma is a facial-disfiguring childhood disease. Targeted interventions and preventive measures during childhood can be vital in controlling Noma incidence.
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Farley E, Karinja MN, Lawal AM, Olaleye M, Muhammad S, Umar M, Gaya FK, Mbaeri SC, Sherlock M, Kabila DW, Peters M, Samuel J, Maloba G, Usman R, van der Kam S, Ritmeijer K, Ariti C, Amirtharajah M, Lenglet A, Falq G. Proportion of paediatric admissions with any stage of noma at the Anka General Hospital, northwest Nigeria. PLoS Negl Trop Dis 2023; 17:e0011508. [PMID: 37889919 PMCID: PMC10645368 DOI: 10.1371/journal.pntd.0011508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/14/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Noma is a rapidly spreading infection of the oral cavity which mainly affects young children. Without early treatment, it can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to understand the prevalence of all stages of noma in hospitalised children. METHODS We conducted a prospective observational study from 1st June to 24th October 2021, enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting parents/ guardians of participants were interviewed at admission. Participants had anthropometric and oral examinations at admission and discharge. FINDINGS Of the 2346 patients, 58 (2.5%) were diagnosed with simple gingivitis and six (n = 0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n = 37, CI 2.5-4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n = 21, CI 1.1-2.6%) (p = 0.008). Risk factors identified for having simple gingivitis included being aged over two years (2 to 6 yrs old, odds ratio (OR) 3.4, CI 1.77-6.5; 7 to 12 yrs OR 5.0, CI 1.7-14.6; p = <0.001), being admitted to the ITFC (OR 2.1; CI 1.22-3.62) and having oral health issues in the three months prior to the assessment (OR 18.75; CI 10.65, 33.01). All (n = 4/4) those aged six months to five years acute necrotizing gingivitis had chronic malnutrition. CONCLUSION Our study showed a small proportion of children admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Hospital admission with malnutrition was a risk factor for both simple and acute necrotizing gingivitis. The lack of access to and uptake of oral health care indicates a strong need for oral examinations to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.
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Affiliation(s)
- Elise Farley
- Médecins Sans Frontières, Noma Children’s Hospital, Sokoto, Nigeria
| | | | | | - Michael Olaleye
- Médecins Sans Frontières, Noma Children’s Hospital, Sokoto, Nigeria
| | - Sadiya Muhammad
- Médecins Sans Frontières, Nigeria Mission, Zamfara and Abuja, Nigeria
| | - Maryam Umar
- Médecins Sans Frontières, Nigeria Mission, Zamfara and Abuja, Nigeria
| | | | | | | | | | - Miriam Peters
- Médecins Sans Frontières, Nigeria Mission, Zamfara and Abuja, Nigeria
| | - Joseph Samuel
- Médecins Sans Frontières, Noma Children’s Hospital, Sokoto, Nigeria
| | - Guy Maloba
- Médecins Sans Frontières, Nigeria Mission, Zamfara and Abuja, Nigeria
| | - Rabi Usman
- Zamfara Ministry of Health, Zamfara, Nigeria
| | | | | | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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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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Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4844. [PMID: 36891565 PMCID: PMC9988273 DOI: 10.1097/gox.0000000000004844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/19/2023] [Indexed: 03/08/2023]
Abstract
Noma is an infectious disease affecting mostly children aged 0-10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa's Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from the gums and progressively expanding into the cheek, nose, or eye regions. In an estimated 90% of cases, the disease is lethal as a result of systemic sepsis. For survivors, typical results are extensive defects of the cheek, nose, and periorbital and perioral regions. Due to the defects, extensive scarring is common, which leads to secondary problems such as growth alterations in an infant's skeleton due to inhibition and restraint of growth resulting typically in cicatricial skeletal hypoplasia. Other sequelae include trismus, partially caused by scarring or complete fusion between maxilla/zygomatic arch and mandible. The resulting overall disfiguring facial appearance results in patients being disabled and socially isolated. Methods Facing Africa is a UK-based non-governmental organization that treats the secondary problems of Ethiopian noma survivors. Operations are performed in Addis Ababa by a visiting expert team. Postoperatively, patients are seen annually for years after the surgery. Results This article discusses basic principles, goals, and a practical surgical algorithm for operating on lip, cheek, and oral defects, based on 210 noma patients who were operated on in Ethiopia over a period of 11 years. Conclusions The suggested algorithm has proven to work for the Facing Africa team members and is considered shareware for all surgeons to use and benefit from.
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Azañedo D, Visconti-Lopez FJ, Hernández-Vásquez A. A Web of Science-Based Bibliometric Analysis of Global Noma Publications. Trop Med Infect Dis 2022; 7:tropicalmed7080198. [PMID: 36006290 PMCID: PMC9412599 DOI: 10.3390/tropicalmed7080198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
The World Health Organization recognizes noma as a global health problem and has suggested prioritizing research into this disease. A bibliographic search of original articles published in the Web of Science database up to 2022 was performed. A bibliometric analysis was carried out with the bibliometrix package in R and VOSviewer. We identified 251 articles published in 130 journals. The first publication was in 1975, the highest number of publications was in 2003, and the average number of citations per document was 12.59. The author with the highest number of publications was Enwonwu CO, and the Noma Children's Hospital had the highest number of articles on this topic. Plastic and Reconstructive Surgery was the journal with the most publications, and the study by Petersen PE was the most cited. The country of corresponding authors that had the most publications and the most significant number of total citations was the United States. "Children" and "Reconstruction" were the most used keywords. In conclusion, there are few publications on noma worldwide, confirming the neglected status of this disease. Urgent actions are needed to increase evidence in regard to the epidemiology of noma and public health interventions to mitigate the ravages of this disease.
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Affiliation(s)
- Diego Azañedo
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima 15067, Peru
| | | | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15024, Peru
- Correspondence:
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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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Davies TC. The position of geochemical variables as causal co-factors of diseases of unknown aetiology. SN APPLIED SCIENCES 2022; 4:236. [PMID: 35909942 PMCID: PMC9326422 DOI: 10.1007/s42452-022-05113-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract The term diseases of unknown aetiology (DUA) or idiopathic diseases is used to describe diseases that are of uncertain or unknown cause or origin. Among plausible geoenvironmental co-factors in causation of DUA, this article focusses on the entry of trace elements, including metals and metalloids into humans, and their involvement in humoral and cellular immune responses, representing potentially toxic agents with implications as co-factors for certain DUA. Several trace elements/metals/metalloids (micronutrients) play vital roles as co-factors for essential enzymes and antioxidant molecules, thus, conferring protection against disease. However, inborn errors of trace element/metal/metalloid metabolisms can occur to produce toxicity, such as when there are basic defects in the element transport mechanism. Ultimately, it is the amount of trace element, metal or metalloid that is taken up, its mode of accumulation in human tissues, and related geomedical attributes such as the chemical form and bioavailability that decisively determine whether the exerted effects are toxic or beneficial. Several case descriptions of DUA that are common worldwide are given to illustrate our knowledge so far of how trace element/metal/metalloid interactions in the immune system may engender its dysregulation and be implicated as causal co-factors of DUA. Article highlights The importance of a proper understanding of geochemical perturbations in human metabolisms is emphasisedIt is proferred that such an understanding would aid greatly in the decipherment of diseases of unknown aetiology (DUA)The thesis presented may pave the way towards better diagnosis and therapy of DUA.
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Affiliation(s)
- Theophilus C. Davies
- Present Address: Faculty of Natural Sciences, Mangosuthu University of Technology, 511 Mangosuthu Highway, 4031, KwaZulu Natal, South Africa
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12
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Kagoné M, Mpinga EK, Dupuis M, Moussa-Pham MSA, Srour ML, Grema MSM, Zacharie NB, Baratti-Mayer D. Noma: Experiences of Survivors, Opinion Leaders and Healthcare Professionals in Burkina Faso. Trop Med Infect Dis 2022; 7:142. [PMID: 35878152 PMCID: PMC9316781 DOI: 10.3390/tropicalmed7070142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
The scientific literature on noma (Cancrum Oris) has clearly increased in recent decades, but there seems to have been limited analysis of issues around the psycho-social impacts of this disease. Even when these issues have been addressed, the focus has tended to be on patient experiences, whereas the community dimension of the disease and the role of healthcare professionals and community leaders in mitigating these impacts remain largely unexplored. A study in the form of semi-directed interviews with 20 noma survivors and 10 healthcare professionals and community leaders was conducted between January and March 2021 in Burkina Faso with the aim of describing the experiences of noma survivors, generating knowledge about living with the burden of the disease and understanding the attitudes of community leaders towards the disease. The results reveal that noma is a disease that affects economically vulnerable populations and leads to extreme household poverty. As far as treatment is concerned, patients tend to turn to practitioners of both traditional and modern medicine. Within communities, noma survivors face discrimination and stigma. The study highlighted a lack of information and knowledge about noma. However, surgical operations lead to patient satisfaction and these remain one of the coping strategies used to tackle the stigma and discrimination. The recommendations set out in this article are aimed firstly at stepping up research into the psycho-social impacts of noma, and secondly at considering these impacts in regional programmes and national plans to combat the disease.
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Affiliation(s)
- Moubassira Kagoné
- Nouna Health Research Centre, National Institute of Public Health, Ouagadougou, Burkina Faso;
| | - Emmanuel Kabengele Mpinga
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.-P.); (D.B.-M.)
| | - Marc Dupuis
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, 1010 Lausanne, Switzerland;
| | | | | | - Maïna Sani Malam Grema
- Faculté des Lettres et Sciences Humaines, University Abdou Moumouni of Niamey, Niamey 10896, Niger;
| | - Ngoyi-Bukonda Zacharie
- Department of Public Health Sciences, Wichita State University, Wichita, KS 67260, USA;
- Faculty of Health Sciences, National Pedagogical University, Kinshasa, Democratic Republic of the Congo
| | - Denise Baratti-Mayer
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.-P.); (D.B.-M.)
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, 1202 Geneva, Switzerland
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13
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Mpinga EK, Srour ML, Moussa MSA, Dupuis M, Kagoné M, Grema MSM, Zacharie NB, Baratti-Mayer D. Economic and Social Costs of Noma: Design and Application of an Estimation Model to Niger and Burkina Faso. Trop Med Infect Dis 2022; 7:tropicalmed7070119. [PMID: 35878131 PMCID: PMC9317383 DOI: 10.3390/tropicalmed7070119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/08/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
Background: While noma affects hundreds of thousands of children every year, taking their lives, disfiguring them and leaving them permanently disabled, the economic and social costs of the disease have not been previously estimated. An understanding of the nature and levels of these costs is much needed to formulate and implement strategies for the prevention and control of this disease, or to mitigate its burden. The objectives of our study were to develop a model for estimating the economic and social costs of noma and to provide estimates by applying this model to the specific contexts of two countries in the “noma belt”, namely Burkina Faso and Niger. Methods: Three main approaches were used. The estimation of prevalence levels of potential noma cases and of cases that should receive and actually do receive medical care was carried out using a literature review. The documentary approach made it possible to estimate the direct costs of noma by analyzing the database of a non-governmental organization operating in this field and present in both countries. Indirect costs were estimated using the human capital method and the cost component analysis technique. Results: The direct costs of care and management of noma survivors amount to approximately USD 30 million per year in Burkina Faso, compared to approximately USD 31 million in Niger. They mainly include costs for medical treatment, surgery, hospital stays, physiological care, psychological care, social assistance, schooling, vocational training and care abroad. Indirect costs are estimated at around 20 million in lost production costs in Burkina and around 16 million in Niger. Costs related to premature deaths are estimated at more than USD 3.5 billion in Burkina Faso and USD 3 billion in Niger. Finally, the costs to survivors who are unable to marry are around USD 13.4 million in Burkina and around USD 15 million in Niger. Intangible costs were not calculated. Conclusions: The neglect of noma and inaction in terms of prevention and control of the disease have enormous economic and social costs for households, communities and states. Future studies of this kind are necessary and useful to raise awareness and eradicate this disease, which impacts the health and well-being of children and results in lifelong suffering and severe economic and social costs to survivors and their families.
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Affiliation(s)
- Emmanuel Kabengele Mpinga
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.); (D.B.-M.)
- Correspondence:
| | | | - Marie-Solène Adamou Moussa
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.); (D.B.-M.)
| | - Marc Dupuis
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
| | - Moubassira Kagoné
- Centre de Recherche en Santé de Nouna, National Institute of Public Health, Ouagadougou, Burkina Faso;
| | - Maïna Sani Malam Grema
- Faculté des Lettres et Sciences Humaines, University Abdou Moumouni of Niamey, Niamey, Niger;
| | - Ngoyi-Bukonda Zacharie
- Department of Public Health Sciences, Wichita State University, Wichita, KS 67260, USA;
- Faculté des Sciences de la Santé, Université Pédagogique Nationale, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Denise Baratti-Mayer
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.); (D.B.-M.)
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14
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Abstract
Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, poverty-stricken communities, mainly in sub-Saharan Africa, and much more rarely in central Latin America and in parts of Asia. In South Africa and in Zimbabwe, noma is observed, again rarely, in immunosuppressed HIV-seropositive subjects. The World Health Organization (WHO) has classified noma into five sequential stages: stage 1, acute necrotising ulcerative gingivitis; stage 2, oedema; stage 3, gangrene; stage 4, scarring; stage 5, sequela. In the opinion of the authors, this WHO classification requires fundamental re-appraisal. The purpose of this viewpoint article is to highlight the weaknesses of this classification, and to propose a simpler, more logical and practical evidence-based staging of noma, which if used should improve the quality and value of future epidemiological data about noma.
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Affiliation(s)
- Razia Abdool Gafaar Khammissa
- Department of Periodontics and Oral Medicine, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Johan Lemmer
- Department of Oral Medicine and Periodontology, University of the Witwatersrand, Johannesburg, South Africa
| | - Liviu Feller
- , 111 Portman Place, Fir Avenue, Bantry Bay, Cape Town, 8005, South Africa
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15
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Ogbureke KUE. Noma: A Neglected Area for Research. J Dent Res 2022; 101:1424-1429. [PMID: 35622443 DOI: 10.1177/00220345221100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Noma, a debilitating and destructive orofacial gangrene, remains endemic in the poor countries of sub-Saharan Africa and other noma hotbeds across the globe, mainly in countries characterized as underdeveloped economies with significant impoverished populations. Noma mostly affects children and infants. This is in spite of the universally held notion that noma is a preventable disease. Indeed, the current noma status quo has been cast as a human rights shortfall, since this devasting disease overwhelmingly affects children from poor countries. At the recently held Noma Research Day, a renewed call for the World Health Organization (WHO) to recognize and include noma as one of the neglected tropical diseases was accompanied by a recognition that research into all aspects of noma has waned or remained completely lacking-particularly that which addresses the basic science questions of the etiology, pathophysiology/pathobiology, and underlying mechanisms of the disease. Yet, a lack of incremental knowledge on the various aspects of noma continues to hamper our composite understanding of its biology. Without a fundamental understanding of the biology of noma, current preventive measures and treatment modalities will continue to fall short of the goals of prevention and eradication. This opinion piece draws renewed attention to the urgency of listing noma as a neglected tropical disease by the WHO. It also calls for major international research funding agencies, including the WHO and the National Institutes of Health, to renew their resolve to robustly fund structured, collaborative, and coordinated proposals that address questions on the epidemiology, etiology, pathophysiology/pathobiology, and molecular mechanisms of the disease. This is with a view to achieving more effective public health approaches toward prevention and to designing potential therapeutic regimens for early lesions. These steps are key to the ultimate eradication of noma.
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Affiliation(s)
- K U E Ogbureke
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center, Houston, TX, USA
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16
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Bala M, Gbolahan OO, Taiwo AO, Braimah RO, Ibikunle AA, Abubakar MK. Is Blood Transfusion Justified During Soft Tissue Surgery in Noma Patients? A One-Year Appraisal at Noma Children Hospital, Sokoto, Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:1-6. [PMID: 36213815 PMCID: PMC9536404 DOI: 10.4103/jwas.jwas_55_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Non-utilization of blood and inappropriate blood transfusion are common in surgical operations. Some surgical procedures are associated with minimal bleeding that does not warrant blood transfusion. No previous study has looked at the pattern of blood loss in noma defect repair to determine the possible need for blood transfusion. AIM/OBJECTIVES This study aimed to determine the total amount of blood loss, the number of units of blood transfused, and the correlation between estimated blood loss and total operating time in patients who had surgical correction of noma defects. MATERIALS AND METHODS This is a hospital-based cross-sectional study of 35 patients who underwent surgical correction of noma defects. Age, sex, pre- and post-operative haemoglobin (Hb), number of requested blood units, total operating time, and total estimated blood loss were recorded. The methods used for the blood loss estimation were gauze swabs, Abdo-packs, drapes, and suction bottles. RESULTS Comparison of the mean pre- and post-operative Hb did not yield any statistically significant difference. The total estimated blood loss in these surgeries was in the range of 65-209 mL, with a mean of 117.20 ± 35.88 mL. No correlation between estimated blood loss and total operating time was noted (P = 0.940). No blood was transfused in any of the subjects. CONCLUSION This study observed minimal blood loss in surgical corrections of the soft tissue noma defect. Apart from blood grouping, there may be no need for routine cross-matching of blood pre-operatively for surgical repair of noma defect. However, more studies are needed to buttress this finding.
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Affiliation(s)
- Mujtaba Bala
- Department of Oral and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | | | - Abdurrazaq Olanrewaju Taiwo
- Department of Oral and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ramat Oyebunmi Braimah
- Department of Oral and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Adebayo Aremu Ibikunle
- Department of Oral and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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17
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Park J, Kim S, Shin SW, Lyu CJ, Kim D. Noma disease (cancrum oris, orofacial gangrene) in an acute myeloid leukemia patient: a case report. J Med Case Rep 2022; 16:97. [PMID: 35255972 PMCID: PMC8903611 DOI: 10.1186/s13256-022-03317-7] [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: 03/08/2021] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Noma is a rare disease that occurs mainly in malnourished patients in developing countries. Noma starts as facial swelling and gingival necrosis that eventually necrotizes underlying tissues including the jaw bone, leaving severe disfigurement. It is reported extremely rarely in patients with severe immunosuppression or blood dyscrasia. Case presentation The gingivitis that occurred in a 12-year-old Asian female patient with acute myeloid leukemia was getting increasingly worse. Although the proper treatment was done, the patient’s condition did not improve, and eventually, a large full-thickness defect was left in the maxillofacial part. Conclusions Early diagnosis and management is the only way to prevent the progression, which leads to facial disfigurement. We present a case of noma in a pediatric acute myeloid leukemia patient, in which oral function was restored through surgical intervention.
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Affiliation(s)
- Jiho Park
- Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sanghun Kim
- Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Seung-Woo Shin
- Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chuhl Joo Lyu
- Department of Pediatrics, College of Medicine, Yonsei University, Seoul, Korea
| | - Dongwook Kim
- Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea.
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18
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Prevalence, incidence, and reported global distribution of noma: a systematic literature review. THE LANCET INFECTIOUS DISEASES 2022; 22:e221-e230. [DOI: 10.1016/s1473-3099(21)00698-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
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19
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Feller L, Lemmer J, Khammissa RAG. OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:884-888. [PMID: 35576473 PMCID: PMC9526837 DOI: 10.1093/trstmh/trac043] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/02/2022] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Noma is a debilitating orofacial necrotizing bacterial disease that disproportionately affects impoverished malnourished persons, particularly young children, the vast majority of whom live in tropical and subtropical areas in sub-Saharan Africa. It has a very high mortality rate; causes significant physical and psychological morbidity, stigmatization and social discrimination; could be prevented, controlled and indeed eliminated by common public health interventions; and is overlooked with regard to public health awareness, in-depth scientific research activities and allocation of funding for prevention, treatment and research. According to the WHO, noma comprises five sequential ‘stages’: (1) necrotizing gingivitis, (2) edema, (3) gangrene, (4) scarring and (5) sequelae. This WHO staging of noma is contentious, leading to diagnostic confusion with misestimation of the number of noma cases reported in epidemiological studies. We therefore suggest a simpler, more practical and scientifically valid two-stage classification comprising only (1) acute noma and (2) arrested noma. Noma meets all the WHO criteria for classification as a neglected tropical disease (NTD). Most survivors of noma live with gross physical disfigurement and disability, and with impaired psychosocial functioning, so they are very often stigmatized and unjustifiably discriminated against. Owing to the paucity of evidence-based epidemiological data on noma, the relatively low number of people affected worldwide, and its apparently limited geographic distribution, noma does not yet feature on the WHO's list of NTDs, or on any global health agenda, and thus has not become a health priority for global action. We strongly support the inclusion of noma within the WHO list of NTDs. Without doubt this will increase the awareness of noma among healthcare providers and promote the systematic international accumulation and recording of data about noma.
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Affiliation(s)
- Liviu Feller
- Department of periodontics and Oral Medicine, Corner Dr Savage and Steve Biko Road, Pretoria, 0001, South Africa
| | - Johan Lemmer
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, University of the Witwatersrand, Johannesburg, South Africa
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20
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Bala M, Omotayo SA, Braimah RO, Taiwo AO, Jaafar R, Abubakar AB, Abubakar MK, Saleh AA. Knowledge, Attitude, and Practices of Primary Health-Care Workers toward NOMA Disease in Sokoto. DENTISTRY AND MEDICAL RESEARCH 2022. [DOI: 10.4103/dmr.dmr_33_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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21
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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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22
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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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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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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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Farley E, Ariti C, Amirtharajah M, Kamu C, Oluyide B, Shoaib M, Isah S, Adetunji AS, Saleh F, Ihekweazu C, Pereboom M, Sherlock M. Noma, a neglected disease: A viewpoint article. PLoS Negl Trop Dis 2021; 15:e0009437. [PMID: 34138861 PMCID: PMC8211204 DOI: 10.1371/journal.pntd.0009437] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Elise Farley
- Médecins Sans Frontières, Sokoto, Nigeria
- Noma Children’s Hospital, Sokoto, Nigeria
- * E-mail:
| | - Cono Ariti
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | | | - Charity Kamu
- Médecins Sans Frontières, Sokoto, Nigeria
- Noma Children’s Hospital, Sokoto, Nigeria
| | | | | | | | | | - Fatima Saleh
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - Mark Sherlock
- Médecins Sans Frontières, Amsterdam, the Netherlands
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Ding X, Wang QQ, Zhou Y, Xu JC. Case Report: Malignant Transformation of Noma: Repair by Forearm Flap. Am J Trop Med Hyg 2020; 103:1697-1699. [PMID: 32783790 DOI: 10.4269/ajtmh.19-0899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Noma is a progressive infectious disease manifested by a necrotic ulcer of the mouth and face. It usually occurs in poor, malnourished children, with about 30,000-140,000 cases each year and a low survival rate. The exact cause of noma remains unclear, but bacterial infection has been postulated to be a major cause of this disease. Antibiotics and improved nutrition could help inhibit the progression of noma, but most patients still require oral surgery because of the bacterial infection-induced tissue damage. In this study, we report an unusual case of a noma patient whose facial lesion developed a malignancy. The necrotic tissue and infectious area were surgically resected, and a forearm flap was used to repair the patient's facial defect. This case aimed at increasing people's awareness of tropical diseases such as noma.
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Affiliation(s)
- Xiang Ding
- Department of Stomatology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Qian-Qian Wang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Yang Zhou
- Editorial Department of Journal of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Jin-Cheng Xu
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
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27
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Leite MGM, Freitas EDS, de Vasconcelos Ii AJA, Pinheiro TN. Low-Level Laser Therapy Approach of Bilateral Necrotizing Sialometaplasia of the Hard and Soft Palates. J Lasers Med Sci 2020; 11:348-354. [PMID: 32802297 DOI: 10.34172/jlms.2020.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Necrotizing sialometaplasia (NS) is a rare locally destructive inflammatory benign disease that commonly affects the minor salivary glands. It is frequently associated with the glands located in the posterior portion of the hard and soft palates. Low-level laser therapy (LLLT), also called photobiomodulation therapy (PBMT), has been deemed a substantial method for the regenerative wound process. Case Presentation: A 32-year-old male patient was referred with a chief complaint of two asymptomatic crater-like ulcers measuring approximately 1.5 cm wide on the right side of the hard and soft palates, and another measuring 0.3 cm wide on the left side of the hard palate. The lesion had two weeks of evolution followed by a previous infectious "sore throat" event that kept the patient hospitalized for 4 days. A clinical diagnosis of NS was made. LLLT was applied during 2 sessions per week, favoring the total wound healing within 2 weeks. At 3 months of clinical followup, the patient did not present any complication or relapse and was thus released. Conclusion: This is, to our knowledge, the first clinical report of LLLT applied for the management of NS. Large palatal ulcers caused by NS usually have long healing periods. The shortened healing period observed in this case encourages the inclusion of LLLT in any treatment protocol for similar lesions.
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Affiliation(s)
- Milena Gomes Melo Leite
- Undergraduate Student, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
| | - Eliandro de Souza Freitas
- Undergraduate Student, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
| | | | - Tiago Novaes Pinheiro
- DDS, MSc, PhD, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
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28
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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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29
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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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30
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Denouement. Pediatr Infect Dis J 2020; 39:261. [PMID: 32032313 DOI: 10.1097/01.inf.0000655864.04992.f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Farley E, Lenglet A, Abubakar A, Bil K, Fotso A, Oluyide B, Tirima S, Mehta U, Stringer B. Language and beliefs in relation to noma: a qualitative study, northwest Nigeria. PLoS Negl Trop Dis 2020; 14:e0007972. [PMID: 31971944 PMCID: PMC6999908 DOI: 10.1371/journal.pntd.0007972] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/04/2020] [Accepted: 12/05/2019] [Indexed: 11/28/2022] Open
Abstract
Background Noma is an orofacial gangrene that rapidly disintegrates the tissues of the face. Little is known about noma, as most patients live in underserved and inaccessible regions. We aimed to assess the descriptive language used and beliefs around noma, at the Noma Children’s Hospital in Sokoto, Nigeria. Findings will be used to inform prevention programs. Methods Five focus group discussions (FGD) were held with caretakers of patients with noma who were admitted to the hospital at the time of interview, and 12 in-depth interviews (IDI) were held with staff at the hospital. Topic guides used for interviews were adapted to encourage the natural flow of conversation. Emergent codes, patterns and themes were deciphered from the data derived from IDI’s and FGDs. Results Our study uncovered two main themes: names, descriptions and explanations for the disease, and risks and consequences of noma. Naming of the disease differed between caretakers and heath care workers. The general names used for noma illustrate the beliefs and social system used to explain the disease. Beliefs were varied; participant responses demonstrate a wide range of understanding of the disease and its causes. Difficulty in accessing care for patients with noma was evident and the findings suggest a variety of actions taking place before reaching a health center or health worker. Patient caretakers mentioned that barriers to care included a lack of knowledge regarding this medical condition, as well as a lack of trust in seeking medical care. Participants in our study spoke of the mental health strain the disease placed on them, particularly due to the stigma that is associated with noma. Conclusions Caretaker and practitioner perspectives enhance our understanding of the disease in this context and can be used to improve treatment and prevention programs, and to better understand barriers to accessing health care. Differences in disease naming illustrate the difference in beliefs about the disease. This has an impact on health seeking behaviours, which for noma cases has important ramifications on outcomes, due to the rapid progression of the disease. Noma (cancrum oris) is an orofacial gangrene that rapidly disintegrates the hard and soft tissues of the face. Little is known about noma as most cases live in underserved and inaccessible regions. We aimed to assess the language used and beliefs around noma, in northwest Nigeria. Findings will be used to inform prevention programs. Five focus group discussions were held with caretakers of patients with noma admitted to the hospital at the time of interview, and 12 in-depth interviews were held with staff at the hospital. Our study uncovered two main themes: names; descriptions and explanations for the disease, and risks and consequences of noma. Naming of the disease differed between caretakers and heath care workers. Difficulty in accessing care for patients with noma was evident. Barriers to care and lack of knowledge and trust were evident. The impact of noma was not limited to physical presentation; stigmatisation was mentioned as a key difficulty. Differences in disease naming illustrate the difference in beliefs and has an impact on health seeking behaviour, which for noma cases, has severe ramifications due to the rapid progression of the disease.
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Affiliation(s)
- Elise Farley
- Médecins Sans Frontières, Nigeria
- Department of Public Health Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Center, The Netherlands
| | | | - Karla Bil
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | | | | | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
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Rickard J, Beilman G, Forrester J, Sawyer R, Stephen A, Weiser TG, Valenzuela J. Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs. Surg Infect (Larchmt) 2019; 21:478-494. [PMID: 31816263 DOI: 10.1089/sur.2019.142] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The burden of surgical infections in low- and middle-income countries (LMICs) remains poorly defined compared with high-income countries. Although there are common infections necessitating surgery prevalent across the world, such as appendicitis and peptic ulcer disease, other conditions are more localized geographically. To date, comprehensive assessment of the burden of surgically treatable infections or sequelae of surgical infections in LMICs is lacking. Methods: We reviewed the literature to define the burden of surgical infections in LMICs and characterize the needs and challenges of addressing this issue. Results: Surgical infections comprise a broad range of diseases including intra-abdominal, skin and soft tissue, and healthcare-associated infections and other infectious processes. Treatment of surgical infections requires a functional surgical ecosystem, microbiology services, and appropriate and effective antimicrobial therapy. Systems must be developed and maintained to evaluate screening, prevention, and treatment strategies. Solutions and interventions are proposed focusing on reducing the burden of disease, improving surveillance, strengthening antibiotic stewardship, and enhancing the management of surgical infections. Conclusions: Surgical infections constitute a large burden of disease globally. Challenges to management in LMICs include a shortage of trained personnel and material resources. The increasing rate of antimicrobial drug resistance, likely related to antibiotic misuse, adds to the challenges. Development of surveillance, infection prevention, and antimicrobial stewardship programs are initial steps forward. Education is critical and should begin early in training, be an active process, and be sustained through regular programs.
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Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gregory Beilman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph Forrester
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Robert Sawyer
- Department of Surgery, Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Andrew Stephen
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Julie Valenzuela
- Department of Surgery, Northwell Health, New Hyde Park, New York, USA
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Brattström-Stolt L, Funk T, Sié A, Ndiaye C, Alfvén T. Noma-knowledge and practice competence among primary healthcare workers: a cross-sectional study in Burkina Faso. Int Health 2019; 11:290-296. [PMID: 30561632 DOI: 10.1093/inthealth/ihy088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/30/2018] [Accepted: 10/24/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Noma is a quickly progressing, neglected opportunistic infection. It starts in the mouth as an oral lesion but can relatively quickly develop into extensive facial destruction and lead to death if not treated in time. This study aims to shed light on primary healthcare workers' practice competences in working with and knowledge of noma. METHODS A structured questionnaire using questions and case scenarios was filled out by 76 healthcare workers in Burkina Faso. Half of the nurses included in this study participated in a 2-day noma training. Data were analysed descriptively and Fisher's exact test was used to study differences between occupational groups using Stata. RESULTS Most healthcare workers reported having examined the mouth of children with diseases predisposing to noma. The total practice competence was poor, with almost 70% having suboptimal or very low competences. However, competences varied between different stages of noma disease. Knowledge scores varied between occupational groups. The majority of nurses and odontostomatology specialist nurses had optimal or good knowledge of noma. Significant differences in knowledge and practice competence were found between nurses who attended a 2-day training course on noma and those who did not. CONCLUSIONS Health care workers in this study had quite poor practice competences in managing noma. The knowledge scores of these health workers were moderate. It is important for healthcare workers to be able to identify noma patients at an early stage, as at this point the disease can still be completely reversed.
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Affiliation(s)
| | - Tjede Funk
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Charlotte Ndiaye
- Regional Advisor for Oral Health, World Health Organization Regional Office for Africa, Harare, Zimbabwe
| | - Tobias Alfvén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
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Feller L, Khammissa RAG, Altini M, Lemmer J. Noma (cancrum oris): An unresolved global challenge. Periodontol 2000 2019; 80:189-199. [PMID: 31090145 PMCID: PMC7328761 DOI: 10.1111/prd.12275] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Noma (canrum oris) is a mutilating necrotizing disease of uncertain etiology, but it is accepted that it is caused primarily by a polybacterial infection with secondary ischemia. The consequent necrotizing fasciitis, myonecrosis, and osteonecrosis results in destruction of facial structures with severe functional impairment and disfigurement. It most frequently affects children, particularly in sub‐Saharan Africa, who are malnourished or debilitated by systemic conditions including but not limited to malaria, measles, and tuberculosis; and less frequently debilitated HIV‐seropositive subjects. In the vast majority of cases, in susceptible subjects, noma is preceded by necrotizing stomatitis. However, it has been reported, albeit rarely, that noma can arise without any preceding oral lesions being observed. Noma is not recurrent and is not transmissible.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Razia A G Khammissa
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mario Altini
- Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Johan Lemmer
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Sociodemographic Characteristics of Traditional Healers and Their Knowledge of Noma: A Descriptive Survey in Three Regions of Mali. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224587. [PMID: 31752451 PMCID: PMC6888258 DOI: 10.3390/ijerph16224587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 01/15/2023]
Abstract
Background: Noma can be a lethal disease and causes disfigurement in young children in low-resource countries, particularly in Africa. In these settings, 80% of the population mainly consult traditional healers for healthcare problems. Our study aimed to describe the sociodemographic characteristics of traditional healers and to assess their knowledge of noma. Methods: We conducted a survey among traditional healers in three Malian regions from May 2015 to January 2016 and collected data on sociodemographic characteristics, professional activity, knowledge, and experience of noma and collaboration with modern medicine. Results: Among 770 traditional healers invited to participate, 732 responded (95%) (mean age, 54.5 years). Most were illiterate (66.3%), which was associated with older age (p < 0.001). Although they treated all types of disease, only 10.5% had some knowledge of noma, with regional differences (p < 0.001). Conclusion: Noma is poorly known among traditional healers, especially in remote areas. Our findings suggest a lack of interest among young people for traditional medicine, implying an imminent decrease of healers, and thus the need for national health systems to strengthen and promote access to modern health care. Training programmes to improve the early diagnosis referral of noma patients should include all types of primary health workers.
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36
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Bello SA, Adeoye JA, Oketade I, Akadiri OA. Estimated incidence and Prevalence of noma in north central Nigeria, 2010-2018: A retrospective study. PLoS Negl Trop Dis 2019; 13:e0007574. [PMID: 31329580 PMCID: PMC6675129 DOI: 10.1371/journal.pntd.0007574] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 08/01/2019] [Accepted: 06/24/2019] [Indexed: 11/18/2022] Open
Abstract
Background Noma is a spreading and fulminant disease believed to be native to Sub-Saharan Africa over the last decade and associated with low socioeconomic status of citizens of the region. Within this noma belt, most epidemiological reports regarding the disease have emanated from the north western region of Nigeria. However, our indigenous surgical mission encountered a substantial number of cases of noma and post-noma defects noteworthy of epidemiological representation across north central Nigeria. Methods All noma cases encountered within the 8-year study period were included and divided based on clinical signs into acute and sequelae groups. Incidence estimation was based on acute/recently active cases and was calculated using the statistical method proposed by the WHO Oral Health Unit (1994). Period prevalence of noma was calculated considering the population at risk in the zone. Findings A total of 78 subjects were included in the study with age ranging from 2–75 years. Twelve subjects (15.4%) presented with acute disease while 66 (84.6%) had various forms of post-noma defects. The estimated incidence of noma in the north central zone was 8.3 per 100000 with a range of 4.1–17.9 per 100000 across various states. Period prevalence of noma which incorporated all cases seen within the study period was 1.6 per 100000 population at risk. Conclusion Although noma may be more prevalent in the north western region of Nigeria, substantial number of cases occurs within the north central zone which calls for deliberate public awareness campaign on disease risk factors and prevention, and education of primary health-care providers. Noma, a devouring disease of the orofacial complex, is commonly associated with poverty and impoverished regions of the world especially Sub-Saharan Africa termed the noma belt region of the world. With more reports advocating for full inclusion of noma in the WHO Neglected Tropical Diseases (NTDs) program, the apparent neglect of the disease in north central Nigeria compared to other sub-regions is worrisome as the disease burden in the sub-region has not been reported till date. In this light, a retrospective, cross-sectional survey was conducted to provide epidemiological representation to the cases encountered within an eight-year period by the Cleft and Facial Deformity Foundation (CFDF), an indigenous surgical mission. The incidence of noma was estimated using methods recommended by WHO while the period prevalence was calculated considering the population living below poverty line in the sub-region. This study extrapolates an incidence of 8.3 cases per 100000 and a period prevalence of 1.6 per 100000 persons at risk. Notable is the finding that most individuals encountered were above thirty years of age and suffered varying degree of facial disfigurement consequent to acute noma disease experienced in their childhood/early adolescence. Therefore, we advocate public awareness on the disease risk factors and prevention within the sub-region as well as training of primary health personnel on disease identification, primary care and nearest referral centres. We also identify the need to bolster the efforts of existing health facilities and indigenous surgical missions in the management and rehabilitation of noma cases and survivors.
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Affiliation(s)
- Seidu A. Bello
- Research Division, Cleft and Facial Deformity Foundation (CFDF), International Craniofacial Academy, Gwarinpa, Abuja, Federal Capital Territory, Nigeria
- * E-mail:
| | - John A. Adeoye
- Research Division, Cleft and Facial Deformity Foundation (CFDF), International Craniofacial Academy, Gwarinpa, Abuja, Federal Capital Territory, Nigeria
| | - Ifeoluwa Oketade
- Research Division, Cleft and Facial Deformity Foundation (CFDF), International Craniofacial Academy, Gwarinpa, Abuja, Federal Capital Territory, Nigeria
| | - Oladimeji A. Akadiri
- Research Division, Cleft and Facial Deformity Foundation (CFDF), International Craniofacial Academy, Gwarinpa, Abuja, Federal Capital Territory, Nigeria
- Department of Oral and Maxillofacial Surgery, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
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Ahlgren M, Funk T, Marimo C, Ndiaye C, Alfvén T. Management of noma: practice competence and knowledge among healthcare workers in a rural district of Zambia. Glob Health Action 2018; 10:1340253. [PMID: 28678680 PMCID: PMC5533138 DOI: 10.1080/16549716.2017.1340253] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Noma is an infectious but opportunistic disease that often results in severe facial disfigurements and mortality if untreated. As noma progresses quickly, early detection and treatment are important to prevent its development. Objectives: The objective of this study was to investigate primary healthcare workers’ knowledge and management of noma in a rural part of Zambia. Methods: A cross-sectional self-completed survey was conducted among 35 healthcare workers from two district hospitals and 15 rural health centres in Serenje District, Zambia. Participants’ practice competences and knowledge were grouped into ‘optimal’, ‘medium’, ‘suboptimal’ and ‘very low’. Results: Most of the healthcare workers stated that they perform mouth examination of a child below five years of age who is suffering from measles, malnutrition or HIV. A majority diagnosed gingivitis correctly and 40% had a medium level of practice competence of the same noma stage. All participants had a suboptimal or very low level on overall practice competence regarding management of noma and two-thirds had a very low level of reported knowledge. Conclusion: General knowledge on noma and competences of diagnosing and treating noma patients was low among healthcare workers. Lack of knowledge could present a barrier for correctly managing noma at an early stage. Improving knowledge among healthcare workers is one way to prevent the development of the disease. In order to prevent noma from the start, actions need to be focussed on improving (oral) hygiene and health education as well. Telemedicine could also be considered as it can help healthcare workers in handling noma patients through enabling communication and exchange of information with specialist.
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Affiliation(s)
- Mathilda Ahlgren
- a Global Health-Health Systems and Policy, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Tjede Funk
- a Global Health-Health Systems and Policy, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Clemence Marimo
- b School of Medicine , Cavendish University Zambia , Lusaka , Zambia
| | - Charlotte Ndiaye
- c Regional Advisor for Oral Health , WHO Regional Office for Africa , Harare , Zimbabwe
| | - Tobias Alfvén
- a Global Health-Health Systems and Policy, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,d Sachs' Children and Youth Hospital , Stockholm South General Hospital , Stockholm , Sweden
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Farley E, Lenglet A, Ariti C, Jiya NM, Adetunji AS, van der Kam S, Bil K. Risk factors for diagnosed noma in northwest Nigeria: A case-control study, 2017. PLoS Negl Trop Dis 2018; 12:e0006631. [PMID: 30138374 PMCID: PMC6107110 DOI: 10.1371/journal.pntd.0006631] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/22/2018] [Indexed: 01/22/2023] Open
Abstract
Background Noma (cancrum oris), a neglected tropical disease, rapidly disintegrates the hard and soft tissue of the face and leads to severe disfiguration and high mortality. The disease is poorly understood. We aimed to estimate risk factors for diagnosed noma to better guide existing prevention and treatment strategies using a case-control study design. Methods Cases were patients admitted between May 2015 and June 2016, who were under 15 years of age at reported onset of the disease. Controls were individuals matched to cases by village, age and sex. Caretakers answered the questionnaires. Risk factors for diagnosed noma were estimated by calculating unadjusted and adjusted odds ratios (ORs) and respective 95% confidence intervals (CI) using conditional logistic regression. Findings We included 74 cases and 222 controls (both median age 5 (IQR 3, 15)). Five cases (6.5%) and 36 (16.2%) controls had a vaccination card (p = 0.03). Vaccination coverage for polio and measles was below 7% in both groups. The two main reported water sources were a bore hole in the village (cases n = 27, 35.1%; controls n = 63, 28.4%; p = 0.08), and a well in the compound (cases n = 24, 31.2%; controls n = 102, 45.9%; p = 0.08). The adjusted analysis identified potential risk and protective factors for diagnosed noma which need further exploration. These include the potential risk factor of the child being fed pap every day (OR 9.8; CI 1.5, 62.7); and potential protective factors including the mother being the primary caretaker (OR 0.08; CI 0.01, 0.5); the caretaker being married (OR 0.006; CI 0.0006, 0.5) and colostrum being given to the baby (OR 0.4; CI 0.09, 2.09). Interpretation This study suggests that social conditions and infant feeding practices are potentially associated with being a diagnosed noma case in northwest Nigeria; these findings warrant further investigation into these factors. Noma or cancrum oris is an orofacial gangrene that rapidly disintegrates the hard and soft tissue of the face. Little is known about noma as most cases live in underserved, difficult to reach locations. There is a dearth of literature on the risk factors for the development of noma. Médecins Sans Frontières (MSF) in collaboration with the Nigerian Ministry of Health runs projects at the Noma Children’s Hospital in Sokoto. A case control study was conducted in northwest Nigeria to explore exposures associated with diagnosed noma using unadjusted and adjusted conditional logistic regression models. Potential risk and protective factors for diagnosed noma were identified and these findings need further exploration. The study identified that feeding pap to the child every day was a potential risk factor for diagnosed noma (possibly a proxy for poor variety in the diet). The following potential protective factors for diagnosed noma were identified: the mother being the primary caretaker, the caretaker being married, and colostrum being given to the baby. Noma is a neglected disease, and current risk factors suggest that intervention efforts could be more effective by focussing on access to health care, the benefits of breastfeeding and a varied diet. However, more research is needed in order to better understand the pathogenesis of this disease in order to improve prevention, early detection and treatment.
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Affiliation(s)
- Elise Farley
- Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands
- Department of Public Health Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Annick Lenglet
- Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands
| | - Cono Ariti
- Centre for Medical Education, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Nma M. Jiya
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Adeniyi Semiyu Adetunji
- Department of Plastic Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Department of Clinical Services, Noma Children’s Hospital, Sokoto, Nigeria
| | - Saskia van der Kam
- Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands
| | - Karla Bil
- Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands
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The surgical management of extra-articular ankylosis in noma patients. Int J Oral Maxillofac Surg 2018; 47:1527-1533. [PMID: 30104131 DOI: 10.1016/j.ijom.2018.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/06/2018] [Accepted: 07/17/2018] [Indexed: 01/24/2023]
Abstract
Extraarticular ankylosis occurs frequently in children suffering from noma sequelae. Over 20years of operating on these patients, we observed high recurrence of mouth opening limitation. We therefore progressively changed our surgical strategy. This retrospective study compares the impact of different parameters (types of surgery, noma type, physiotherapy compliance, age and sex) on immediate and long-term mouth opening. It includes a series of 121 patients with extraarticular ankylosis operated on between 1990 and 2015. Soft tissue reconstruction evolved from local and pedicled flaps to large free flaps. Mouth opening was performed by bone-bridge excision, sometimes associated to contralateral coronoidectomy. Mouth opening technique including bilateral coronoidectomy with free flap reconstruction was the only independent factor for significantly better immediate mouth opening with a mean increase of 8.7mm [95% confidence interval (CI) 4.3-13.1, P<0.001) and this effect was maintained in the 3years of follow-up. Another positive factor related to long-term results was excellent physiotherapy, while noma type 4 was a negative factor. Recurrence remains problematic in the management of noma sequelae. If physiotherapy and long-term follow-up cannot be offered, patients should not be operated on, because if limitation of mouth opening recurs, oral feeding may become impossible when a facial defect has been reconstructed.
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Baratti-Mayer D, Gayet-Ageron A, Cionca N, Mossi MA, Pittet D, Mombelli A. Acute necrotising gingivitis in young children from villages with and without noma in Niger and its association with sociodemographic factors, nutritional status and oral hygiene practices: results of a population-based survey. BMJ Glob Health 2017; 2:e000253. [PMID: 29082004 PMCID: PMC5656129 DOI: 10.1136/bmjgh-2016-000253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/09/2017] [Accepted: 03/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background Previous studies have suggested that acute necrotising gingivitis precedes noma disease and that noma clusters in some villages in certain regions of low- and middle-income countries. We sought to assess the prevalence of gingivitis with bleeding in young children from villages with or without a history of noma and to analyse epidemiological differences related to sociodemographic characteristics, nutritional status and oral hygiene practices. Methods We conducted a cross-sectional study in 440 children aged between 2 and 6 years from four villages in the Zinder region of southeast Niger in Africa. In two villages, cases of noma have repeatedly been detected; in the other two, noma has never been identified. We randomly selected 110 participants from each village. Results The prevalence of acute necrotising gingivitis was significantly higher in the noma villages compared with the non-noma villages (6.8% vs 0.9%; p=0.001). We found differences between the four villages regarding socioeconomic factors, stunting, undernourishment and oral hygiene practices. The type of oral hygiene procedures influenced the amount of dental plaque and gingival inflammation. Children using sand, coal or other abrasive products instead of a toothbrush had a significantly increased likelihood to be diagnosed with acute necrotising gingivitis (p=0.041). Conclusions Our data suggest that efforts to prevent noma should focus on populations with a high prevalence of acute necrotising gingivitis and include nutritional support and attempts to introduce safe and efficient oral hygiene practices to improve gingival health.
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Affiliation(s)
- Denise Baratti-Mayer
- GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Department of Community Health and Medicine, Division of Clinical Epidemiology, University of Geneva Hospitals, Geneva, Switzerland.,Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Norbert Cionca
- Division of Periodontology, School of Dental Medicine, University of Geneva Faculty of Medicine, Geneva, Switzerland
| | | | - Didier Pittet
- GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Andrea Mombelli
- GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Division of Periodontology, School of Dental Medicine, University of Geneva Faculty of Medicine, Geneva, Switzerland
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Lee YJ, Kim YJ, Won CH, Chang SE, Lee MW, Choi JH. Nomalike Necrotizing Stomatitis in a Child with Crohn's Disease. Pediatr Dermatol 2017; 34:e275-e276. [PMID: 28783211 DOI: 10.1111/pde.13212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noma is an opportunistic infection characterized by devastating gangrenous stomatitis leading to severe tissue destruction that predominantly affects malnourished children in sub-Saharan Africa. Only a few cases have been reported in immunocompromised patients from developed countries. We present an unusual case of nomalike necrotizing stomatitis in a previously healthy child with Crohn's disease in Korea.
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Affiliation(s)
- Ye Jin Lee
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Young Jae Kim
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Noma in an HIV infected patient in Guinea-Bissau: a case report. Infection 2017; 45:897-901. [PMID: 28589415 DOI: 10.1007/s15010-017-1034-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Noma is a multifactorial and multibacterial opportunistic infection that initially causes necrotic gingivitis but rapidly spreads to the nearby orofacial tissue resulting in sloughing and severe deformation of the facial structures. The majority of cases are seen in young children under the age of 6 years. Noma is strongly associated with poverty, malnutrition and immunosuppression, and is often preceded by severe systemic infections such as measles and malaria. Only few cases of noma infection in adults have been described. CASE REPORT We present here a case report with a 32-year-old Guinean woman who was diagnosed with noma infection and on that occasion discovered that she was HIV-1 seropositive. After treatment with amoxicillin/clavulanic acid and metronidazole for her noma infection the woman was transferred to the national hospital where antiretroviral treatment was initiated. CONCLUSION Noma is an opportunistic infection and immunodeficiencies such as HIV should always be suspected when presenting in an adult patient.
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Tungotyo M. Noma as a complication of false teeth (Ebiino) extraction: a case report. J Med Case Rep 2017; 11:112. [PMID: 28412977 PMCID: PMC5393018 DOI: 10.1186/s13256-017-1276-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ebiino, also known as false tooth extraction, is a traditional practice done mainly in the remote areas of African countries, including Uganda. It involves the extraction of tooth buds in babies with common childhood illnesses such as fever, cough, and diarrhea. It is thought that the tooth buds are responsible for the ailments seen in these infants. The practice is performed by traditional healers using unsterile instruments. The complications associated with this dangerous practice have been mentioned in the literature and include anemia and septicemia, among others. This case report describes a baby with noma, an orofacial gangrenous infection. Case presentation A 16-month-old girl from western Uganda belonging to the Banyankole ethnic group was admitted to Mbarara University Teaching Hospital with a 5-day history of a dark lesion on the left cheek. The lesion had started from the left upper gum at the site where a tooth bud had been extracted 1 week prior to admission. The child had experienced occasional cough and fever and also had erupting tooth buds. These tooth buds had been seen as the cause of the cough and fever by the traditional herbalist; hence, they were extracted. An unsterile instrument had been used for the procedure. At the hospital, a local examination showed necrotic tissue involving the left cheek and extending into the left upper gingival area of the girl’s mouth. A clinical diagnosis of orofacial gangrene (noma) was then made. Conclusions Ebiino, or false tooth extraction, is still practiced in some remote areas of Uganda. Noma has been mentioned as a possible complication of this traditional practice; however, case reports in the literature are scant. Public awareness of the dangers of this practice is therefore still required to prevent this dangerous complication.
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Affiliation(s)
- Martin Tungotyo
- Mbarara University of Science and Technology, Mbarara, Uganda.
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Srour ML, Marck K, Baratti-Mayer D. Noma: Overview of a Neglected Disease and Human Rights Violation. Am J Trop Med Hyg 2017; 96:268-274. [PMID: 28093536 DOI: 10.4269/ajtmh.16-0718] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/30/2016] [Indexed: 11/07/2022] Open
Abstract
Noma is an orofacial gangrene affecting malnourished children and mainly observed in tropical countries, particularly sub-Saharan Africa. Epidemiological data on noma are scarce, but a current estimate of the global incidence is 30,000-40,000 cases per year, with a mortality rate of approximately 85% and a burden of disease calculated to be a loss of 1-10 million disability-adjusted life years. The etiology of noma is multifactorial with malnutrition as an ever present factor, often in combination with concomitant diseases, such as measles, malaria, and human immunodeficiency virus (HIV), and poor oral hygiene. The pathogenesis is a fast-spreading, noncontagious gangrenous infection occurring in the face, often preceded by acute necrotizing gingivitis, and stomatitis. Rare microbiological studies suggest an opportunistic infection caused by an imbalance in normal intraoral microorganisms. Prevention lies in food security, measles vaccination, prevention of malaria and HIV, including the early detection and treatment of necrotizing gingivitis and stomatitis. Early treatment with antibiotics may prevent gangrene or reduce its extent. Late treatment consists of surgical rehabilitation, which is often complex. However, access to medical care is very limited for noma patients due to the extremely poor conditions in which they live that are frequently located in remote rural areas. The authors support the United Nations Human Rights Council Resolution 19/7 adopted on March 22, 2012 "The right to food," and advocate for the inclusion of noma on the list of neglected tropical diseases to encourage more medical and institutional attention for this often lethal or very mutilating infectious gangrene.
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Affiliation(s)
| | - Klaas Marck
- Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Denise Baratti-Mayer
- Geneva Study Group on Noma (GESNOMA), Service of Plastic and Reconstructive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Rüegg EM, Gniadek P, Modarressi A, Baratti-Mayer D, Pittet-Cuénod B. Facial bone reconstruction with prefabricated vascularized calvarium flaps in children and young adults: Advantages and long-term results. J Craniomaxillofac Surg 2016; 44:1880-1888. [PMID: 27765551 DOI: 10.1016/j.jcms.2016.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/05/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Reconstruction of facial bone defects in children is challenging. The use of well-vascularized bone is mandatory to obtain stable lasting results. This study reports our experience of facial bone reconstruction using prefabricated vascularized calvarium flaps. METHODS Retrospective case series of 50 patients who underwent 52 maxillary, malar, and mandibular reconstructions between 1988 and 2014 using prefabricated vascularized calvarium flaps. Forty-nine patients suffered from noma sequels; one patient had craniofacial cleft Tessier 3-11. Surgery consisted of a two-step procedure beginning with flap delay and prelamination with skin grafting on the galea. Flap harvest followed at least 2 weeks later (range, 2-16 weeks), including a full-thickness calvarium fragment, which was set into the facial defect. RESULTS Early complications concerned wound healing and infections requiring surgical revision in six patients at the recipient and six at the donor site. There was one flap loss. Clinical long-term assessment at 15-year median follow-up (range, 1-27 years) showed good results, assuring facial height and contour. Radiological long-term results demonstrated excellent integration of the flap to the adjacent facial skeleton of the growing child. CONCLUSIONS Prefabricated vascularized calvarium flaps are an effective, safe and lasting method for reconstruction of facial bone defects in children.
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Affiliation(s)
- Eva Meia Rüegg
- Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Paul Gniadek
- Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Ali Modarressi
- Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Denise Baratti-Mayer
- Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Brigitte Pittet-Cuénod
- Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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Herrera D, Alonso B, de Arriba L, Santa Cruz I, Serrano C, Sanz M. Acute periodontal lesions. Periodontol 2000 2015; 65:149-77. [PMID: 24738591 DOI: 10.1111/prd.12022] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
Abstract
This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.
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Ashok N, Tarakji B, Darwish S, Rodrigues JC, Altamimi MA. A Review on Noma: A Recent Update. Glob J Health Sci 2015; 8:53-9. [PMID: 26573028 PMCID: PMC4873589 DOI: 10.5539/gjhs.v8n4p53] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/09/2015] [Indexed: 11/16/2022] Open
Abstract
Noma is a gangrenous infection primarily affecting under developed countries. The aim of this paper was to review all recent articles on noma from January 2003 to August 2014 and briefly update the latest information related to the topic. A literature search was done on PUBMED using the keywords “noma / cancrum oris”. Noma is commonly seen in malnourished children. There has been an increased incidence of noma in HIV patients. Apart from these, noma has also been reported in association with cyclic neutropenia, herpetic stomatitis, leukemia, Down's syndrome and Burkett's disease. Treatment of acute noma includes transfusion of blood and intravenous fluids, administration of antibiotics, putting the patient on a high protein diet and debridement of necrotic areas. Surgical phase is usually initiated 6 to 18 months after a period of quiescence. Although, the mortality rate associated with noma has reduced significantly with the advent of modern generation antibiotics, the functional, cosmetic and psychological challenges associated with the destruction of soft or hard tissues still remains a huge challenge. Adequate steps must be implemented by the government or medical professionals to prevent the disease and provide an early intervention.
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Zushi Y, Noguchi K, Moridera K, Takaoka K, Kishimoto H. Osteonecrosis of the jaw in an AIDS patient: a case report. AIDS Res Ther 2015; 12:13. [PMID: 25932039 PMCID: PMC4415315 DOI: 10.1186/s12981-015-0049-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/24/2015] [Indexed: 11/29/2022] Open
Abstract
We report a rare case of osteonecrosis of the jaw following necrotizing gingivitis in a Japanese AIDS patient. Intraoral examination showed exposed necrotic bone in the left mandible and spontaneous loss of teeth. This patient was successfully treated with highly active anti-retroviral therapy combined with minimally invasive surgical procedures to remove the osteonecrosis of the jaw.
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Simon F, Wolfe SA, Guichard B, Bertolus C, Khonsari RH. Paul Tessier facial reconstruction in 1970 Iran, a series of post-noma defects. J Craniomaxillofac Surg 2015; 43:503-9. [PMID: 25817742 DOI: 10.1016/j.jcms.2015.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Paul Tessier was a pioneering plastic surgeon who founded craniofacial surgery and had an international influence in the field of reconstructive surgery. We reviewed his techniques in the reconstruction of post-noma defects in Iran in the late 1970s. PATIENTS AND METHODS We studied a series of 23 patients operated on by Tessier from 1974 to 1978 in Iran (property of Association Française des Chirurgiens de la Face). They all suffered from noma in childhood with major facial defects. RESULTS Ten suffered from simple lip and cheek defects, nine also from nose defects and four from extensive facial defects. Abbe flaps were used in 15 patients to reconstruct the lips completed by commissuroplasty in six patients. Nose defects were reconstructed with nasofrontal flaps (ten cases). The outer cheek was reconstructed with a rotation flap (four cases), or with a frontotemporal flap (six cases). The inner cheek was reconstructed using a Barron-Tessier myocutaneous flap (ten cases). Of the 23 patients, partial flap necrosis occurred in five cases. CONCLUSIONS Tessier was a pioneering plastic surgeon who used local flaps to reconstruct these important facial defects. He had a high rate of success, although nowadays local flaps are commonly replaced by free flaps.
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Affiliation(s)
- François Simon
- AP-HP, Hôpital Pitié-Salpêtrière, Service de chirurgie maxillo-faciale, Paris, F-75013, France; UPMC University Paris 06, F-75005, Paris, France.
| | - S Anthony Wolfe
- Plastic and Reconstructive Surgery, Miami Children's Hospital, 3100 SW 62 Avenue, ACB #2230, Miami, FL, USA
| | - Benjamin Guichard
- Hôpital Charles-Nicolle, Service de chirurgie maxillo-faciale, Rouen, F-76038, France; Université de Rouen, Rouen, France
| | - Chloé Bertolus
- AP-HP, Hôpital Pitié-Salpêtrière, Service de chirurgie maxillo-faciale, Paris, F-75013, France; UPMC University Paris 06, F-75005, Paris, France
| | - Roman Hossein Khonsari
- AP-HP, Hôpital Pitié-Salpêtrière, Service de chirurgie maxillo-faciale, Paris, F-75013, France; UPMC University Paris 06, F-75005, Paris, France
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