Clinico-Pathological Analysis of Osteomyelitis in Cancrum Oris (Noma) Patients Seen in Noma Children Hospital, Northwest Nigeria

Abstract

Background: Cancrum oris is a rapid and devastating infectious disease of the orofacial region, which can be life threatening in its fulminant stage. Infection of bone (osteomyelitis) is a possible sequelae of Noma (cancrum oris) and is more likely due to late presentation especially in our environment. A literature search revealed scanty research describing osteomyelitis in Noma patients.
 Objective: To analyze the clinico–pathology of osteomyelitis in Noma patients diagnosed and treated at Noma Children Hospital, Sokoto.
 Methods: The design was a 2-year retrospective study of records of Thirty–two patients who had sequestrectomy secondary to osteomyelitis in Noma (Cancrum oris). Age, gender, jaws affected and side of involvement were analyzed
 Results: The age ranged from 2–11 years with mean ±standard deviation 5.47 ± 2.68 years was recorded. Osteomyelitis in Noma patients was found among 17 (53.10%) males compared to 15 (46.90%) females. In 20 (62. 50%) of the cases, anterior maxillary involvement was observed and the remaining 12 (37. 50%) was found at the mandibular posterior region and it is more common on the left side. Result of histopathology showed both acute and chronic inflammatory cells. Necrosis and bone hyperactivity was observed in most of the slides.
 Conclusion: Osteomyelitis is a common complication of Noma and its treatment is of paramount importance for adequate management of Noma patients.

Blindness Secondary to Noma Destruction of Orbital Bone: Case Series from Noma Children Hospital Sokoto, Northwest Nigeria

“…Noma begins from simple gingivitis and rapidly progresses to gangrenous stages if not diagnosed early and promptly treated [3]. The resulting gangrene may involve the maxilla and, the mandible, and may extend to the nose and the orbit in an upward spread [4]. Survivors of noma could present with various degrees of facial deformities, trismus or temporomandibular joint ankyloses; resulting in eating problems, oral incontinence, dysphonia and serious psychological problems [5].…”

Knowledge, Attitude and Practices of Health Care Workers towards NOMA in a Tertiary Institution in North-western Nigeria

“…1 It is prevalent in povertystricken communities markedly along the so-called Noma belt of the world. 2 Precise epidemiological data on Noma are lacking globally but recently published articles reported a global incidence of 30,000 to 40,000 cases per year with 75 percent in sub-Saharan Africa. 3,4 The data provided by the foreign non-governmental organization on the incidence of Noma in Nigeria during the last two decades revealed a rate of 0.8 to 6.4 cases in 1000 children.…”

“…8,9 In the absence of any intervention, Noma is fatal in up to 90% of cases due to the sequelae of sepsis that ensues. 2 This rate is reduced to about 8% if prompt and appropriate treatment is instituted. 2 Noma is a disease that starts as acute and progresses in stages.…”

“…2 This rate is reduced to about 8% if prompt and appropriate treatment is instituted. 2 Noma is a disease that starts as acute and progresses in stages. 10 World Health Organization recognizes six stages which include; simple gingivitis (stage 0), acute necrotizing ulcerative gingivitis (stage 1), facial swelling/edema (stage 2), gangrene (stage 3), scarring (stage 4), and, sequelae (stage 5).…”