Clinical Experience in the Treatment of Noma Sequelae

Pittet, Brigitte; Jaquinet, A.; Montandon, Denys

doi:10.1097/00001665-200105000-00014

Cited by 49 publications

(21 citation statements)

References 14 publications

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“…In our patient, antibiotics were able to control the infection even when the predisposing acute leukaemia remained undiagnosed and untreated. Most common Noma sequelae described are unilateral loss of the whole cheek, maxilla, palate and malar bone 13. The same sequelae was seen in our patient.…”

Section: Global Health Problem Analysissupporting

confidence: 86%

Noma in a child with acute leukaemia: when the ‘face of poverty’ finds an ally

et al. 2016

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A 2-year-6-month old, appropriately immunised, well-thriving boy, symptomatic for the past 6 months, presented with recurrent fever, progressive pallor, lymphadenopathy and a raw area on the right cheek, with discharging sinus. The necrotising infection of the face developed after one and half months of febrile illness. This febrile illness with bicytopaenia was diagnosed as enteric fever and treated with antibiotics. Skin grafting was performed for the full-thickness defect of the face. The patient continued to have a non-healing oral ulcer with progressive pallor and was finally diagnosed as having acute lymphoblastic leukaemia. Immunodeficiency was ruled out by appropriate investigations. Noma is an indirect measure of extreme poverty, but malignancy is known to predispose to this debilitating condition. The worldwide incidence of Noma is reported to be 30 000–140 000, with a preponderance in sub-Saharan Africa. This case emphasises the need for a thorough search for the underlying illness predisposing to a rare opportunistic infection such as Noma in a well-thriving child.

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Section: Global Health Problem Analysissupporting

confidence: 86%

Noma in a child with acute leukaemia: when the ‘face of poverty’ finds an ally

et al. 2016

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“…Further studies of postoperative distractor handling and longterm outcomes with respect to trismus are certainly required. 41 …”

Section: Resultsmentioning

confidence: 99%

Noma: Experiences with a Microvascular Approach under West African Conditions

Giessler

Schmidt

2003

Plastic and Reconstructive Surgery

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Noma (cancrum oris) is a serious ulcerating disease that generally begins in the gingival sulcus of children. One of the main areas of prevalence today is West Africa. If noma is survived, it results in disfiguring midfacial defects and intense scarring. Oral incompetence is often combined with trismus resulting from scar formation or bony fusion between the maxilla and the mandible. Reconstructive approaches with pedicled flaps from the head or shoulder area for closure of the outer defects have been prone to donor-site complications or have not properly addressed the trismus, leading to high recurrence rates. During three West African Interplast missions, a single-stage procedure was developed for reconstruction of the inner and outer linings of the oral, nasal, and paranasal cavities, with restoration of jaw function. The procedure consists of radical scar excision, placement of an external distractor for mouth opening, and primary closure of the defect with a folded free parascapular flap for full-thickness coverage. Twenty-three patients with various noma-related defects were treated with this procedure; two cases are described in detail. This combined treatment can be a safe successful procedure for patients with noma, especially those with severe soft-tissue destruction and profound trismus, even under demanding surgical conditions.

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“…The study of patient defects enables us, like other authors (Tempest, 1966;Adams-Ray and James, 1992;Pittet et al, 2001;Giessler et al, 2005), to distinguish two main reconstruction issues, in central defects with the nose and premaxilla (type II) and in lateral defects with the cheek and jaw constriction (type I and IV). The lip and especially the upper lip was almost always concerned in both reconstructions.…”

Section: Discussionmentioning

confidence: 97%