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Gebretsadik HG, Abera Y. High burden of noma in the Gambella region of Ethiopia: a 12-year retrospective study on noma cases from the Facing Africa database. Trans R Soc Trop Med Hyg 2024; 118:505-513. [PMID: 38591224 DOI: 10.1093/trstmh/trae015] [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: 10/26/2023] [Revised: 12/13/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Noma, an infectious disease, mainly affects impoverished children. This study retrospectively assessed noma's prevalence in Ethiopia using data from the Facing Africa database and the 2022 United Nations Development Programme poverty index report. METHODS A thorough review of medical records spanning 2007 to 2019 identified a total of 235 noma cases. A standardized data extraction template was employed to systematically gather pertinent clinical and demographic data for subsequent analysis. Prevalence rates were calculated nationally and regionally for both the general population and children aged ≤10 y. RESULTS The analysis revealed estimated national prevalence rates of 0.65 per 100 000 individuals at risk and 1.9 per 100 000 children aged <10 y at risk. The Gambela region exhibited the highest prevalence rate (11.2 per 100 000), whereas the Benshangul Gumuz region had the lowest (0.25 per 100 000). Similar patterns were observed among children aged ≤10 y, with the Gambela and Benshangul Gumuz regions reporting rates of 32.9 and 0.74 per 100 000, respectively. CONCLUSIONS The study highlights noma's significant impact on children aged <10 y in Ethiopia, especially in the Gambella region. It offers crucial baseline data to assist public health professionals, policymakers and healthcare providers in formulating evidence-based strategies to combat noma and improve affected individuals' well-being.
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Affiliation(s)
| | - Yenigat Abera
- Department of Global Health, School of Global Health & Bioethics, Euclid University, Banjul, Gambia
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Longo BM, Merli M, Achana B, Okao M, Smart Okot G, Ribero S, Calcagno A, Montrucchio G, Orlotti C. A noma case report: A warning message from Northern Uganda. Trop Med Int Health 2024; 29:752-755. [PMID: 38946064 DOI: 10.1111/tmi.14025] [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] [Indexed: 07/02/2024]
Abstract
Noma, or Cancrum oris, is a severe and rapidly progressing gangrenous infection that primarily affects the face. It is most commonly observed in children living in impoverished conditions, especially in sub-Saharan Africa. Rapid diagnosis and early management are crucial to prevent devastating consequences, such as functional limitations and serious psychological repercussions. Herein, we present a case of an 8-month-old child affected by noma, whose positive outcome is attributed to the prompt recognition by healthcare personnel. In our patient, the condition was likely related to malnutrition and the preceding extraction of a deciduous tooth reported by the mother and probably associated with a traditional Ugandan practice called Ebiino. This is the second case reported in Uganda, and given the limited healthcare access in most of the country, coupled with the high prevalence of poverty and other predisposing factors, it becomes evident that the incidence of noma is underestimated. Noma, as a neglected disease, requires greater awareness within communities and among healthcare professionals. A collective effort is needed to significantly reduce risk factors and promote prevention of this life-threatening disease.
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Affiliation(s)
- Bianca Maria Longo
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, at "Amedeo di Savoia" Hospital, ASL "Città di Torino", Turin, Italy
| | - Martina Merli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Bonny Achana
- Department of Surgical Sciences, Dr. Ambrosoli Memorial Hospital, Kalongo, Uganda
| | - Maurice Okao
- Department of Surgical Sciences, Dr. Ambrosoli Memorial Hospital, Kalongo, Uganda
| | - Godfrey Smart Okot
- Department of Surgical Sciences, Dr. Ambrosoli Memorial Hospital, Kalongo, Uganda
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, at "Amedeo di Savoia" Hospital, ASL "Città di Torino", Turin, Italy
| | - Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Anaesthesia, Critical Care and Emergency, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Carmen Orlotti
- Department of Surgical Sciences, Dr. Ambrosoli Memorial Hospital, Kalongo, Uganda
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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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Eleje GU, Okoh EE, Igbodike EP, Akinsolu FT, Nwaokorie FO, Lusher JM, Tantawi ME, Salako AO, Ezechi OC, Foláyan MO. 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
| | - Morẹ́nikẹ́ 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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Ainsworth S. Noma finally recognised as a neglected tropical disease. PLoS Negl Trop Dis 2024; 18:e0012177. [PMID: 38814853 PMCID: PMC11139265 DOI: 10.1371/journal.pntd.0012177] [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: 06/01/2024] Open
Abstract
In December 2023, after decades of tireless advocacy from stakeholders and partners, the World Health Organization (WHO) gave noma the long overdue recognition as a neglected tropical disease. The significance of this official recognition cannot be overstated, and it is hoped this will serve as a turning point in our battle against this devastating disease.
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Affiliation(s)
- Stuart Ainsworth
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- International Noma Network (www.internationalnomanetwork.org)
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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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Gebretsadik HG. Surgical Procedures, Complications, and Durations in Patients with Noma Disease: A Cross-sectional Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5496. [PMID: 38115840 PMCID: PMC10730030 DOI: 10.1097/gox.0000000000005496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023]
Abstract
Background Noma is a devastating disease that causes severe destruction of facial tissue, necessitating comprehensive surgical intervention for functional restoration and improved quality of life. This cross-sectional study aimed to identify common surgical procedures used for noma defect reconstruction in Ethiopia, analyze their durations, and assess associated complications. Methods The study retrospectively analyzed noma patient records from Facing Africa's database, covering electronic medical data from 2007 to 2019, and utilized SPSS version 2020 for analysis. Results Facing Africa treated 235 noma cases (2007-2019) with 438 procedures. The most commonly used surgical technique was reconstructive surgery, which encompassed two or more other surgical methods and was used in 177 cases. This was followed by the submental flap in 47 cases and ankylosis release in 35 cases. The study also found complications in 11 cases, including flap necrosis, abscesses, and ankylosis-related mouth restriction. Additionally, the analysis of 102 noma cases revealed significant variations in the duration of surgical procedures, ranging from 10 to 48 hours for specific cases, with the majority (63.7%) requiring 2 to 5 hours. The mean duration of noma surgery was calculated to be 4.08 hours. Conclusions Comprehending common surgical techniques, complications, and durations benefits surgical planning, resource allocation, and patient care. Thus, the results of this study are a useful contribution to the development of effective noma treatment. However, further research and continuous efforts are needed to refine surgical practices, address potential complications, and enhance patient care in the battle against this devastating disease.
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Affiliation(s)
- Heron G. Gebretsadik
- From the Department of Global Health, School of Global Health & Bioethics, Euclid University, Banjul, Gambia
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Gebretsadik HG, de Kiev LC. A retrospective clinical, multi-center cross-sectional study to assess the severity and sequela of Noma/Cancrum oris in Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010372. [PMID: 36099293 PMCID: PMC9506604 DOI: 10.1371/journal.pntd.0010372] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/23/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal. Materials and methods A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,—the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score. Results A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25–50%), Grade-3 (50–75%), Grade-1 (0–25%), and Grade-4 (75–100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma. Discussion The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one’s family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity. Noma is orofacial gangrene that rapidly disintegrates the hard and soft tissue of the face. The mortality rate of Noma varies between 85–90%. The remaining 10–15% of Noma survivors permanently suffer from severe facial deformities. Noma is a widely neglected disease affecting poor people globally. Most cases of Noma are reported from the so-called Noma belt, located south of the Sahara and runs across Africa from Senegal to Ethiopia. Though Ethiopia is one of the countries in the Noma-belt region where people, particularly children, are significantly affected by the disease, the attention given to this devastating condition is remained to be very low. Therefore, we believe that assessing the severity and sequela of Noma in Ethiopia is crucially essential to lay bare the burden of the disease and increase the overall understanding of the condition among different stakeholders. We are also convinced that the study’s findings can serve as baseline data for further in-depth scientific investigations and preventive policy development.
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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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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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Gezimu W, Demeke A, Duguma A. Noma – a neglected disease of malnutrition and poor oral hygiene: A mini-review. SAGE Open Med 2022; 10:20503121221098110. [PMID: 35707345 PMCID: PMC9190046 DOI: 10.1177/20503121221098110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: The aim of this review was to describe malnutrition and poor oral hygiene, the most common risk factors for noma. Methods: A vigorous literature searches were conducted on databases such as Scopus, Elsevier, Web of Science, PubMed, Virtual Health Library, and Google Scholar by inserting keywords such as ‘noma’ OR ‘cancrum oris’ OR ‘cancrum oris cases’. A total of 65 articles gathered. Of these, 38 articles found to be eligible for this study. Results: A total of 38 full-length articles were included in the review. According to the evidence gathered and summarized in this review, malnutrition, especially protein-energy malnutrition and vitamin deficiencies, makes the oral mucosa susceptible to opportunistic pathogens of noma, and then, in so doing, pathogens invade the oral cavities. Malnutrition has a bidirectional relationship with noma. Since noma is a disease of the oral cavity, poor oral hygiene has the potential of predispose and worsen the disease’s progress. Conclusion: Malnutrition and poor oral hygiene found to be ingrained in the pathogenesis of noma. For effective management and prevention of noma, it is necessary to underpin adequate nutritional supplementation (including vitamins). As a primary prevention strategy, healthcare workers’ training should be strengthened to improve the diagnosis and treatment of oral infections, including noma.
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Affiliation(s)
- Wubishet Gezimu
- Department of Nursing, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Ababo Demeke
- Department of Nursing, College of Health Science, Dilla University, Dilla, Ethiopia
| | - Abdissa Duguma
- Department of Nursing, College of Health Science, Mettu University, Mettu, Ethiopia
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Banda CH, Wilson E, Malata CM, Narushima M, Ogawa T, Hassanein ZM, Shiraishi M, Okada Y, Ghorra DT, Ishiura R, Danno K, Mitsui K, Oni G. Clinical application and outcomes of reconstructive microsurgery in Africa: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2035-2048. [PMID: 35643598 DOI: 10.1016/j.bjps.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/20/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties. However, the practice is underdeveloped in low- and middle-income countries. The aim of this systematic review was to evaluate the clinical application and outcomes of reconstructive microsurgery performed in Africa. METHODS Seven databases (PubMed, Web of Science, MEDLINE, CINAHL, Academic Search Complete, Embase, and Google Scholar) were searched for studies reporting microsurgical procedures performed in Africa. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools and quality of evidence using the GRADE approach. Meta-analysis was performed using a random effects model to estimate the pooled proportion of events with 95% confidence intervals. The primary outcome was free flap success rate, and the secondary outcomes were the complication and flap salvage rates. RESULTS Ninety-two studies were included in the narrative synthesis and nine in the pooled meta-analysis. In total, 1376 free flaps in 1327 patients from 1976 to 2020 were analyzed. Head and neck oncologic reconstruction made up 30% of cases, while breast reconstruction comprised 2%. The pooled flap survival rate was 89% (95% CI: 0.84, 0.93), complication rate 51% (95% CI: 0.36, 0.65), and free flap salvage rate was 45% (95% CI: 0.08, 0.84). CONCLUSION This meta-analysis showed that the free flap success rates in Africa are high and comparable to those reported in high-income countries. However, the comparatively higher complication rate and lower salvage rate suggest a need for improved perioperative care. REVIEW REGISTRATION Registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25th September 2020, ID: CRD42020192344.
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Affiliation(s)
- Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan; Department of Surgery, Arthur Davison Children's Hospital, Ndola, Zambia.
| | - Emma Wilson
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, United Kingdom
| | - Charles M Malata
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Anglia Ruskin University, School of Medicine, Chelmsford, Cambridge, United Kingdom
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Tomoko Ogawa
- Department of Breast Surgery, Mie University, Tsu, Japan
| | - Zeinab M Hassanein
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, United Kingdom
| | - Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Yoshimoto Okada
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Dina T Ghorra
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Plastic and Reconstructive Surgery, Alexandria University, Alexandria, Egypt
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Georgette Oni
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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13
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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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14
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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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15
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Miller LE, Shaye DA. Noma and Necrotizing Fasciitis of the Face and Neck. Facial Plast Surg 2021; 37:439-445. [PMID: 33517575 DOI: 10.1055/s-0041-1722894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Necrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.
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Affiliation(s)
- Lauren E Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - David A Shaye
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.,Doctors without Borders, Noma Project, Sokoto, Nigeria
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16
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Halioua B, Halioua D. Josef Mengele's research program on noma in Auschwitz. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:182-184. [PMID: 32659408 DOI: 10.1016/j.jormas.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
Noma research protocol was conducted in the Auschwitz Birkernau camp by the infamous (Schutzstaffel) SS doctor Josef Mengele who was known as "the Angel of Death" in close collaboration with researchers at the Kaiser-Wilhelm Institute in Berlin Crimes. Mengele who held the post of camp doctor in the "Gypsy camp" saw an opportunity to set up a research program on gypsy children called "Nomaprojekt". The purpose of this program was to study the causes of noma and to find treatment methods. The experimental treatment protocol consisted of administering a combination of sulfanilamido-ethyl thiodiazole and nicotinic acid. Heads and selected body parts of children suffering from noma were prepared in formaldehyde jars and sent to researchers at the prestigious Kaiser-Wilhelm Institute for Anthropology, Human Heredity and Eugenics in Berlin-Dahlem, but also to the SS Medical Academy in Graz to carry out further examinations. The experimental protocol for the treatment of noma among Gypsy children is one of the most horrific crimes that Dr. Josef Mengele committed in the Auschwitz camp.
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Affiliation(s)
| | - D Halioua
- Department of ethical research, université Paris-Sud 11, 94276 Le-Kremlin-Bicêtre cedex, France
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17
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Anaesthetic care for noma (cancrum oris) - the disease, the airway and how to provide anaesthetic care without a clinical safety infrastructure. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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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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19
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Shaye DA, Rabbels J, Adetunji AS, Magee A, Vo D, Winters R. Evaluation of the Noma Disease Burden Within the Noma Belt. JAMA FACIAL PLAST SU 2019; 20:332-333. [PMID: 29800992 DOI: 10.1001/jamafacial.2018.0133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David A Shaye
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, University Teaching Hospital Kigali, University of Rwanda College of Medicine & Health Sciences, Kigali, Rwanda
| | - Jens Rabbels
- Department of Oral and Maxillofacial Surgery, Katharinen Hospital, Stuttgart, Germany
| | | | - Aidan Magee
- Department of Anaesthesia and Critical Care, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Daniel Vo
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan Winters
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana
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20
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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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21
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Shaye DA, Winters R, Rabbels J, Adentunji AS, Magee A, Vo D. Noma surgery. Laryngoscope 2018; 129:96-99. [PMID: 30194753 DOI: 10.1002/lary.27230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/04/2018] [Accepted: 03/20/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Noma is a devastating and destructive disease of the face for which there is a dearth of information regarding surgical options. Herein, we describe the facial deformities and patient characteristics in a patient population affected by noma and the surgical approaches used in treatment. METHODS Retrospective case series of a Doctors Without Borders (Médecins Sans Frontières) intervention at Sokoto Children's Noma Hospital in northern Nigeria, the highest-volume noma hospital in the world. RESULTS Twenty-two procedures were performed on 18 patients with noma, 44% of whom were children. The majority of patients (n = 10, 55.5%) were made aware of surgical care through a Doctors Without Borders outreach program. Patients' reasons for seeking care included functional (61.1%, n = 11), appearance (61.1%, n = 11), and social stigma (66.7%, n = 12). The majority (83.3%, n = 15) had lip involvement. Four patients (22.2%) underwent staged flap procedures including prelamination, flap delay, or pedicle division. The mean duration of surgical procedure was 87 minutes (range 5-306 minutes). The minor complication rate was 16%. There were no major complications or deaths. CONCLUSION Noma is a mutilating disease of the face that occurs in settings of extreme malnutrition. A total of 55.5% of noma patients were made aware of surgical care through outreach programs. The majority of noma patients seek care to improve function (61.1%) and appearance (61.1%), and to address social stigma (66.7%). A total of 83.3% of noma patients had lip involvement. Facial reconstructive surgeons must rely on principles of congenital, traumatic, and oncologic deformity repair while focusing on safe, reliable procedures for low-resource settings. LEVEL OF EVIDENCE 4 Laryngoscope, 129:96-99, 2019.
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Affiliation(s)
- David A Shaye
- Doctors Without Borders, Amsterdam, Holland. Noma Project, Sokoto, Nigeria.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Global Health and Social Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, University Teaching Hospital Kigali, University of Rwanda, College of Medicine & Health Sciences, Kigali, Rwanda
| | - Ryan Winters
- Doctors Without Borders, Amsterdam, Holland. Noma Project, Sokoto, Nigeria.,Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, U.S.A
| | - Jens Rabbels
- Doctors Without Borders, Amsterdam, Holland. Noma Project, Sokoto, Nigeria.,Department of Oral and Maxillofacial Surgery, Katharinen Hospital, Stuttgart, Germany
| | - Adenyiyi Seminyu Adentunji
- Doctors Without Borders, Amsterdam, Holland. Noma Project, Sokoto, Nigeria.,Children's Noma Hospital, Sokoto State, Nigeria
| | - Aidan Magee
- Doctors Without Borders, Amsterdam, Holland. Noma Project, Sokoto, Nigeria.,Department of Anaesthesia and Critical Care, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Daniel Vo
- Doctors Without Borders, Amsterdam, Holland. Noma Project, Sokoto, Nigeria.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
There is growing awareness of the substantial global burden of surgical disease. Conditions treated effectively by plastic and reconstructive procedures make a large proportion of the global surgical diseases, and disproportionately affect individuals at the lower end of the economic spectrum. This article reviews the role of plastic surgery in global health, highlights the ongoing need for plastic and reconstructive surgery globally, and increasing efforts that have been made to meet these needs. There global shortage of plastic surgeons in low and middle income countries, but plastic surgery has a long tradition of humanitarian aid, has been a leader in global surgery development. Plastic and reconstructive surgical care has increasingly been shown to be cost effective and to have an immense impact on the economy of a region, delivering a substantial return on investment. More sustainable global surgical care is essential in future, requiring ongoing efforts from the plastic surgery community, greater recognition of the problems that can be addressed at policy level, and research to help guide policy-makers when facing the decision of allocating scarce resources. There is a fundamental role of plastic surgery in global health.
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23
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Anesthesia in the Humanitarian Context: Coping in Disaster and Emergency Situations. Int Anesthesiol Clin 2018. [PMID: 29521792 DOI: 10.1097/aia.0000000000000182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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25
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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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26
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Rodgers W, Lloyd T, Mizen K, Fourie L, Nishikawa H, Rakhorst H, Schmidt A, Kuoraite D, Bulstrode N, Dunaway D. Microvascular reconstruction of facial defects in settings where resources are limited. Br J Oral Maxillofac Surg 2015; 54:51-6. [PMID: 26608690 DOI: 10.1016/j.bjoms.2015.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 10/19/2015] [Indexed: 11/25/2022]
Abstract
The surgical treatment of defects caused by noma is challenging for the surgeon and the patient. Local flaps are preferred, but sometimes, because of the nature of the disease, there is not enough local tissue available. We describe our experience of free tissue transfer in Ethiopia. Between 2008 and 2014, 34 microsurgical procedures were done over 11 missions with the charity Facing Africa, predominantly for the treatment of defects caused by noma (n=32). The mean duration of operation was 442 minutes (range 200 - 720). Six minor wound infections were treated conservatively and did not affect outcome, a return to theatre was required in 4 patients with wound infections and one with a haemorrhage; 2 flaps failed and 2 partially failed, one patient developed an oronasal fistula, and one had an infection at the donor site that required a repeat graft. In settings where resources are limited, free flaps can be used when local tissue is not available and they cause less morbidity than pedicled tissue transfer.
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Affiliation(s)
- W Rodgers
- Department of Plastic Surgery, Great Ormond Street Hospital for Children, UK.
| | - T Lloyd
- Department of Oral and Maxillofacial Surgery, University College London Hospital, UK
| | - K Mizen
- Department of Oral and Maxillofacial Surgery, The Mid Yorkshire Hospitals NHS Trust, UK
| | - L Fourie
- Department of Plastic Surgery, The Mid Yorkshire Hospitals NHS Trust, UK
| | - H Nishikawa
- Department of Craniofacial Surgery, The Birmingham Children's Hospital, UK
| | - H Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, ZGT Almelo, MST Enschede, The Netherlands
| | - A Schmidt
- Head of South Bavaria Section, Interplast Germany NGO
| | - D Kuoraite
- Department of Human Geography, Exeter University, UK
| | - N Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital for Children, UK
| | - D Dunaway
- Department of Plastic Surgery, Great Ormond Street Hospital for Children, UK
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Zwetyenga N, See LA, Szwebel J, Beuste M, Aragou M, Oeuvrard C, Martin D, Emparanza A. [Noma]. ACTA ACUST UNITED AC 2015; 116:261-79. [PMID: 26235765 DOI: 10.1016/j.revsto.2015.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/23/2015] [Indexed: 11/30/2022]
Abstract
Noma is a necrotizing ulcerative stomatitis known since Antiquity. It occurs mostly in poor countries, the Sahel countries being the most affected. Each year, several hundred thousand cases are reported. Noma affects especially malnourished children who are less than 6 years old and rarely adults with acquired immunodeficiency (HIV, cancer). Ulcerative lesion is occurring rapidly due to the production of endotoxins by bacteria from oral commensal, telluric and animal origin. Necrotic debridement leads to huge defects: loss of soft tissue (skin, nerves, vessels, eye), bone (maxilla, mandible) and teeth. Death occurs rapidly in a few weeks in 80 % of the cases. In case of survival, the consequences are functional, aesthetic, psychological and social. The goal of the treatment in the acute phase is the patient's survival and the fight against limited mouth opening. The management of the phase of sequela is an anaesthetic, surgical and physiotherapy challenge. Its purpose is the social reintegration of the patient.
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Affiliation(s)
- N Zwetyenga
- Service de stomatologie, chirurgie maxillo-faciale, chirurgie plastique esthétique et reconstructrice, chirurgie de la main, centre hospitalier universitaire de Dijon, boulevard Delattre-de-Tassigny, 21000 Dijon, France; Laboratoire EA 4268 4IS, université de Franche-Comte, place Saint-Jacques, 35000 Besançon, France.
| | - L-A See
- Service de stomatologie, chirurgie maxillo-faciale, chirurgie plastique esthétique et reconstructrice, chirurgie de la main, centre hospitalier universitaire de Dijon, boulevard Delattre-de-Tassigny, 21000 Dijon, France
| | - J Szwebel
- Service de chirurgie plastique, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France
| | - M Beuste
- CHRU, 80054 Amiens cedex 1, France
| | - M Aragou
- Département d'anesthésie, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France
| | - C Oeuvrard
- Département d'anesthésie, centre hospitalier universitaire de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | | | - A Emparanza
- Calle Federico García Lorca, 7, 20014, San Sebastian, Espagne
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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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Anyanechi CE, Osunde OD, Bassey GO. Management of extra-capsular temporo-mandibular joint ankylosis: does conservative approach to treatment have a role? J Maxillofac Oral Surg 2015; 14:339-43. [PMID: 26028856 DOI: 10.1007/s12663-014-0625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 04/04/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The conventional management of fibrous extracapsular temporo-mandibular joint (TMJ) ankylosis, a debilitating disease, is associated with surgical complications and financial burden on the patients. OBJECTIVE To assess the outcome of conservative approach to the management of fibrous extracapsular TMJ ankylosis. PATIENTS AND METHODS This is a prospective study of patients who presented at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Nigeria, during the period from January 1999 to December 2012 with a history of inability to open the mouth diagnosed as fibrous extracapsular TMJ ankylosis. RESULTS Twenty-one subjects were treated and their ages ranged from 11 to 22 years with mean at 15.0 years. There were 13 (61.9 %) males and 8 (38.1 %) females with male: female ratio of 1.6:1. The aetiological factor that predisposed to formation of extracapsular TMJ ankylosis was facial trauma. There was no facial asymmetry and the side distribution of the affliction showed that 1 (4.8 %) was bilateral while 20 (95.2 %) were unilateral. Eight cases (38.1 %) were incomplete ankylosis while the rest (n = 13, 61.9 %) were complete. The shorter the duration of fibrous ankylosis and the greater the initial inter-incisal distance before treatment, the better the treatment outcome. CONCLUSION The outcome of treatment suggests that the conservative approach to management of this condition was beneficial to these patients because they presented early. However, randomized controlled clinical trials are needed to validate this treatment option.
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Affiliation(s)
- C E Anyanechi
- Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar/University of Calabar Teaching Hospital, P. O. Box 3446, Calabar, Nigeria
| | - O D Osunde
- Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar/University of Calabar Teaching Hospital, P. O. Box 3446, Calabar, Nigeria
| | - G O Bassey
- Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar/University of Calabar Teaching Hospital, P. O. Box 3446, Calabar, Nigeria
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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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Maley A, Desai M, Parker S. Noma: A disease of poverty presenting at an urban hospital in the United States. JAAD Case Rep 2014; 1:18-20. [PMID: 27075129 PMCID: PMC4802558 DOI: 10.1016/j.jdcr.2014.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alexander Maley
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Grady Health System, Atlanta, Georgia
| | - Megan Desai
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Sareeta Parker
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Grady Health System, Atlanta, Georgia
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Coupe MH, Johnson D, Seigne P, Hamlin B. Airway Management in Reconstructive Surgery for Noma (Cancrum Oris). Anesth Analg 2013; 117:211-8. [DOI: 10.1213/ane.0b013e3182908e6f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bello SA, Aluko Olokun B, Olaitan AA, Ajike SO. Aetiology and presentation of ankylosis of the temporomandibular joint: report of 23 cases from Abuja, Nigeria. Br J Oral Maxillofac Surg 2012; 50:80-4. [PMID: 21255886 DOI: 10.1016/j.bjoms.2010.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 12/17/2010] [Indexed: 11/25/2022]
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Bello SA. Gillies fan flap for the reconstruction of an upper lip defect caused by noma: case presentation. Clin Cosmet Investig Dent 2012; 4:17-20. [PMID: 23674921 PMCID: PMC3652365 DOI: 10.2147/cciden.s31190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The case of a 65-year-old noma patient with a defect involving her upper lip is presented. The defect also included missing teeth numbers eleven, twelve, 21, and 22 and the adjoining alveolus. One-stage lip reconstruction was carried out with Gillies fan flap followed by vestibuloplasty and commissuroplasty. An acrylic partial denture was subsequently fabricated to replace the missing teeth and thereby restore function. Even though the incidence of cancrum oris has reduced worldwide, cases are still being reported in Africa and can leave behind a significant facial defect. Whereas most cases of lip defects reported from the Western world are due to cancer, cancrum oris could be the cause of lip defects in sub-Saharan Africa. Gillies fan flap could be employed for the reconstruction of a relatively large defect of the lip and the disadvantage of microstomia could be minimized for the restoration of articulation, speech, and masticatory functions of the lip.
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Affiliation(s)
- Seidu Adebayo Bello
- Department of Dental and Maxillofacial Surgery, State House Medical Center, Asokoro, Abuja, Nigeria
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35
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Challacombe S, Chidzonga M, Glick M, Hodgson T, Magalhães M, Shiboski C, Owotade F, Ranganathan R, Naidoo S. Global Oral Health Inequalities. Adv Dent Res 2011; 23:227-36. [DOI: 10.1177/0022034511402081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Four oral mucosal infections were identified as Global Oral Health Priorities: (a) HIV and associated viral, bacterial, and fungal infections; (b) tuberculosis; (c) NOMA; and (d) sexually transmitted diseases. Huge global inequalities exist in all four. HIV-associated infections constitute the major challenge. Oral manifestations of AIDS can be specifically diagnostic, indicating a significant role for dentists within health teams. The World Workshops in Oral Health & Disease in AIDS have identified a research program, elements of which are being implemented. Data on oral mucosal involvement in tuberculosis, syphilis, and gonorrhea are incomplete in developed countries and virtually non-existent in low- and middle-income countries, indicating the need for further epidemiological studies. Oral manifestations of tuberculosis and sexually transmitted diseases are largely associated with general health, so action programs should be integrated with agencies treating the systemic diseases. NOMA is very much in the oral health domain. It is a preventable disease associated with malnutrition and unidentified bacterial factors. Prevalence is probably grossly overestimated at present; but nevertheless it constitutes a challenge to the profession, especially in the NOMA belt. Current treatment is surgical, but plans for its eradication should be achievable. The global oral health community, especially the IADR, has a major role to play.
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Affiliation(s)
- S. Challacombe
- Oral Medicine, King’s College London Dental Institute, Central Office, Floor 18, Guys Tower, Guys Hospital, London SE1 9RT, UK
| | - M. Chidzonga
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M. Glick
- University of Buffalo, Buffalo; NY, USA
| | - T. Hodgson
- Eastman Dental Hospital UCLH NHS Foundation Trust and UCL Eastman Dental Institute, UK
| | | | - C. Shiboski
- University of California at San Francisco, USA
| | - F. Owotade
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - S. Naidoo
- University of the Western Cape, Cape Town, South Africa
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Beikler T, Flemmig TF. Oral biofilm-associated diseases: trends and implications for quality of life, systemic health and expenditures. Periodontol 2000 2011; 55:87-103. [PMID: 21134230 DOI: 10.1111/j.1600-0757.2010.00360.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ogbureke KU, Ogbureke EI. NOMA: A Preventable "Scourge" of African Children. Open Dent J 2010; 4:201-6. [PMID: 21243072 PMCID: PMC3020568 DOI: 10.2174/1874210601004010201] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 07/10/2010] [Accepted: 07/19/2010] [Indexed: 11/22/2022] Open
Abstract
Noma is a serious orofacial gangrene originating intraorally in the gingival-oral mucosa complex before spreading extraorally to produce a visibly destructive ulcer. Although cases of noma are now rarely reported in the developed countries, it is still prevalent among children in third world countries, notably in sub-Sahara Africa, where poverty, ignorance, malnutrition, and preventable childhood infections are still common. This review summarizes historical, epidemiological, management, and research updates on noma with suggestions for its prevention and ultimate global eradication. The global annual incidence remains high at about 140,000 cases, with a mortality rate exceeding 90% for untreated diseases. Where the patients survive, noma defects result in unsightly facial disfigurement, intense scarring, trismus, oral incompetence, and social alienation. Although the etiology has long been held to be infectious, a definitive causal role between microorganisms cited, and noma has been difficult to establish. The management of noma with active disease requires antibiotics followed by reconstructive surgery. Current research efforts are focused towards a comprehensive understanding of the epidemiology, and further elucidation of the microbiology and pathogenesis of noma.Although a formidable public health challenge, noma can be prevented with a potential for subsequent global eradication. To achieve both desirable goals, detection of early disease is crucial because these early lesions respond to conventional antibiotic treatments when instituted side by side with nutritional rehabilitation, and obviates the necessity for extensive surgical reconstruction often indicated in late stage disease. The eradication of noma in the developed world in the mid 20(th) century bears out the notion of a similar outcome following effective preventive strategies in Africa. A fundamental and necessary step towards attaining this goal is for the international community to adopt a perception of noma as an urgent global public health challenge. Research effort toward deciphering the microbiology, molecular events, and pathogenesis of noma also should intensify.
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Affiliation(s)
- Kalu U.E Ogbureke
- Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta Georgia, U.S.A
- Department of Oral Health and Diagnostic Sciences, School of Dentistry, Medical College of Georgia, Augusta Georgia, U.S.A
| | - Ezinne I Ogbureke
- Department of Oral Health and Diagnostic Sciences, School of Dentistry, Medical College of Georgia, Augusta Georgia, U.S.A
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Visor flap for total upper and lower lip reconstruction: a case report. J Med Case Rep 2009; 3:7312. [PMID: 19830178 PMCID: PMC2726494 DOI: 10.4076/1752-1947-3-7312] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 01/22/2009] [Indexed: 11/29/2022] Open
Abstract
Introduction Noma, aptly named the 'face of poverty', is a scourge with a mortality rate of up to 90% that affects some 140,000 people each year, predominantly children in the sub-Saharan 'noma belt'. Survivors of the acute attack suffer severe facial disfigurement from loss of facial tissue and scarring. Surgical reconstruction of noma defects is a major challenge, especially in Africa, where the majority of cases occur. Case presentation We report the case of a 40-year-old Somali man who presented with severe facial disfigurement, including total absence of both upper and lower lips. After a failed initial reconstruction, a combination of platysma flaps and a left deltopectoral flap provided mucosal lining, while a scalp visor flap served to recreate upper and lower lips, the beard and moustache. Conclusion The scalp visor flap offers a simple but extremely versatile tool for use in midfacial reconstruction, especially in the male, providing neo-lip tissue, a moustache and a beard. This is the first report of a simultaneous total upper and lower lip reconstruction using a scalp visor flap, in the English literature. We also emphasize on a process of transfer of skills to enable local surgeons to effectively manage the challenge that noma presents.
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Hartman EHM, Van Damme PA, Rayatt S, Kuokkanen HOM. Return of the waltzing flap in noma reconstructive surgery: revisiting the past in difficult circumstances. J Plast Reconstr Aesthet Surg 2009; 63:e80-1. [PMID: 19329369 DOI: 10.1016/j.bjps.2009.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 12/19/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
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Chidzonga MM, Mahomva L. Recurrent noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): report of a case. J Oral Maxillofac Surg 2008; 66:1726-30. [PMID: 18634964 DOI: 10.1016/j.joms.2007.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 08/22/2007] [Indexed: 10/21/2022]
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Chidzonga MM, Mahomva L. Noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): clinical experience in Zimbabwe. J Oral Maxillofac Surg 2008; 66:475-85. [PMID: 18280380 DOI: 10.1016/j.joms.2007.09.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 06/12/2007] [Accepted: 09/05/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE This retrospective study describes the clinical features and management of noma (cancrum oris) in patients with HIV and AIDS. PATIENTS AND METHODS Records of 48 consecutive patients with noma (cancrum oris) seen between July 2002 and November 2006 were reviewed for age, gender, clinical features, and management. Other reports on noma in HIV and AIDS in Zimbabwe were also reviewed. RESULTS There were 48 patients included; 35.4% (n = 17) were males, of which 64.7% (n = 11) were children (16 years and younger) and 35.3% (n = 6) were adults; 64.6% (n = 31) were females, out of which 87.1% (n = 27) were children and 12.9% (n = 4) were adults. The average age was 14.2 years (range, 3 to 30 years) for males and 9.2 years (range, 1 to 36 years) for females. The average age for the entire group was 11 years (range, 1 to 36 years). All patients were HIV-positive by the ELISA method. Only 13 patients had CD4 cell and CD8 cell count obtained, ranging from 10 to 594 cells/microL with a CD4/CD8 ratio ranging from 0.02 to 0.45. Only 5 patients had microbiologic investigations conducted, isolating Staphylococcus aureus, Klebsiella species, group D Streptococcus, and group B hemolytic Streptococcus. Isolated cheek defect (37.5%) was most common, followed by the type I and type IV defect (25% each). Administration of antibiotics, nutritional support, wound debridement, and sequestrectomy were conducted before definitive reconstructive surgery. Facial reconstruction was performed using distant and local advancement flaps. No bony reconstruction was performed. Satisfactory results were achieved with minimal infection and flap breakdown. Follow-up was difficult; patients were lost to follow-up within 6 to 12 months after surgery. CONCLUSION Noma cases are on the increase in line with the current HIV and AIDS epidemic. Female children appear to be more commonly affected than their male counterparts. Reconstructive surgery is possible in patients with low CD4/CD8 ratios because of HIV infection.
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Abstract
Nasofacial phycomycosis caused by Conidiobolus is a rare fungal infection most often encountered in the developing world in conditions of poverty. A clinical presentation of the natural history of this condition observed over a period of 6 years by a visiting volunteer surgical team demonstrates the role of multimodality surgical and antifungal drug treatment in producing a successful outcome. The particular sensitivity of this infection to the new generation antifungal Voriconazole is noted.
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Affiliation(s)
- Mark Harold Moore
- Royal Australasian College of Surgeons Specialist Surgical Project, East Timor.
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Abstract
Noma is an opportunistic infection promoted by extreme poverty. It evolves rapidly from a gingival inflammation to grotesque orofacial gangrene. It occurs worldwide, but is most common in sub-Saharan Africa. The peak incidence of acute noma is at ages 1-4 years, coinciding with the period of linear growth retardation in deprived children. Noma is a scourge in communities with poor environmental sanitation. It results from complex interactions between malnutrition, infections, and compromised immunity. Diseases that commonly precede noma include measles, malaria, severe diarrhoea, and necrotising ulcerative gingivitis. The acute stage responds readily to antibiotic treatment. The sequelae after healing include variable functional and aesthetic impairments, which require reconstructive surgery. Noma can be prevented through promotion of national awareness of the disease, poverty reduction, improved nutrition, promotion of exclusive breastfeeding in the first 3-6 months of life, optimum prenatal care, and timely immunisations against the common childhood diseases.
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Affiliation(s)
- Cyril O Enwonwu
- Department of Biomedical Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA.
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Hartman EHM, Van Damme PA, Sauter H, Suominen SHH. The use of the pedicled supraclavicular flap in noma reconstructive surgery. J Plast Reconstr Aesthet Surg 2006; 59:337-42. [PMID: 16756246 DOI: 10.1016/j.bjps.2005.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Three noma patients with large unilateral facial defects were reconstructed using the pedicled supraclavicular flap technique in the Noma Children Hospital in Sokoto, Nigeria. The results are-although not completely perfect-encouraging enough to report and to repeat the technique in future reconstructive noma surgery after moderate modifications. It is advised not to tunnel the pedicle in the neck, but instead to open the neck. Then, the flap can be inset in a Z-plasty fashion to close the neck without the chance of compression of the pedicle of the flap. In this way flap necrosis can be prevented, without the risk of a scar contracture of the neck. Another technique, which can prevent partial flap necrosis and loss of tissue, with the need for secondary stage interventions, is a delay procedure of the flap. Incorporation of the fascia in the pedicled supraclavicular flap can be another option to fulfil the abovementioned requirements.
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Affiliation(s)
- Ed H M Hartman
- Department of Plastic Surgery, Radboud University Medical Centre Nijmegen, Reinier Postlaan 4, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Eipe N, Neuhoefer ES, La Rosee G, Choudhrie R, Samman N, Kreusch T. Submental intubation for cancrum oris: a case report. Paediatr Anaesth 2005; 15:1009-12. [PMID: 16238567 DOI: 10.1111/j.1460-9592.2005.01573.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cancrum oris (Noma) is a devastating gangrenous disease that leads to severe tissue destruction in the face. We describe the anesthetic management of a 12-year-old girl with cancrum oris sequelae in a Rural Secondary level Hospital in Central India (Padhar Hospital). She presented with a large defect in her upper lip on the left side that extended into the columella and the floor of the left nostril. She was scheduled to undergo reconstructive surgery and the surgeons planned to use an Abbé flap based on the lower lip. For this, access to both the mouth and the nose was required. We considered a tracheostomy but decided to attempt the submental route for orotracheal intubation. Following intravenous induction the patient's trachea was intubated with a cuffed oral tracheal tube. This was passed through the submental incision and then reconnected. The surgery proceeded uneventfully and the patient was extubated before transfer. She made a satisfactory recovery and the submental scar healed without complication or scarring. We describe briefly the features of cancrum oris and review the technique of submental intubation (described in adults with midfacial trauma). The use of submental intubation in children and for cancrum oris sequelae has not been previously reported.
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Affiliation(s)
- Naveen Eipe
- Department of Anaesthesia, Padhar Hospital, Padhar, Betul Dt, Madhya Pradesh, India.
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Revest M, Decaux O, Siegfried D, Carp D, Jego P, Grosbois B. Une fièvre qui n'a pas la dent dure !…. Rev Med Interne 2005; 26 Suppl 2:S279-81. [PMID: 16129174 DOI: 10.1016/s0248-8663(05)81284-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Revest
- Départment de médecine de l'adulte, hôpital Sud, Rennes, France
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Enwonwu CO, Phillips RS, Ferrell CD. Temporal relationship between the occurrence of fresh noma and the timing of linear growth retardation in Nigerian children. Trop Med Int Health 2005; 10:65-73. [PMID: 15655015 DOI: 10.1111/j.1365-3156.2004.01351.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fresh noma (cancrum oris) occurs predominantly in children <4 years of age. The key risk factors are poverty, malnutrition and infections. Evolution from an intraoral inflammation to a grotesque oro-facial gangrene is very rapid. OBJECTIVE We assessed potential relationship between the occurrence of fresh noma and linear growth retardation (LGR) which is prevalent in deprived Third World infants/children between ages 3 and 30 months. LGR is attributed to malnutrition and chronic immunostimulation by environmental antigens. DESIGN Anthropometric evaluation of children (n = 91) with fresh noma, ages 0-8 years, in relation to US National Center for Health Statistics Reference values was carried out. Age-matched noma-free, poor village children (n = 151) from similar communities as noma cases, and elite urban children (n = 132) served as control groups. Heights and weights were measured and the height for age (HAZ), weight for age (WAZ) and weight for height (WHZ) scores calculated as indices of stunting, underweight and wasting respectively. Serum level of interleukin (IL)-18, a multifunctional cytokine, was also measured. RESULTS In the age groups 0-4 and 4-8 years, the percentages of noma children <-2.0SD were 91% and 67% respectively. The corresponding values for the village children were 37% and 24% and significantly different (P < 0.001) from the noma group. Only 7% of the elite children aged 4-8 years were stunted. Low body weight and wasting were prominent features of village and noma groups, but more marked in the latter. Associated with noma was a profound increase (P < 0.001) in IL-18 in comparison with urban controls, and a 34% non-statistically significant increase relative to the village control group. Among other functions, IL-18 induces several pro-inflammatory cytokines and the matrix metalloproteinases, influences long bone growth, and consequently may be relevant to growth retardation seen in poor village children and noma victims. CONCLUSION These results suggest that occurrence of fresh noma was probably programmed very early in life by malnutrition and chronic infections resulting from replacement of breast milk with contaminated, inferior substitutes. Although not investigated, we speculate that children with fresh noma might also be victims of intrauterine growth retardation as noma is most prevalent during the infantile phase of child growth which starts at mid-gestation and tails off at 4 years.
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Affiliation(s)
- Cyril O Enwonwu
- Schools of Dentistry and Medicine, University of Maryland, Baltimore, MD, USA.
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