Outcomes at 18 mo of 37 noma (cancrum oris) cases surgically treated at the Noma Children's Hospital, Sokoto, Nigeria

Abstract

Background Noma is a rapidly progressing infection of the oral cavity frequently resulting in severe facial disfigurement. We present a case series of noma patients surgically treated in northwest Nigeria. Methods A retrospective analysis of routinely collected data (demographics, diagnosis and surgical procedures undergone) and in-person follow-up assessments (anthropometry, mouth opening and quality of life measurements) were conducted with patients who had surgery >6 mo prior to data collection. Results Of the 37 patients included, 21 (56.8%) were male and 22 (62.9%) were aged >6 y. The median number of months between last surgery and follow-up was 18 (IQR 13, 25) mo. At admission, the most severely affected anatomical area was the outer cheek (n = 9; 36.0% of patients had lost between 26% and 50%). The most frequent surgical procedures were the deltopectoral flap (n = 16; 43.2%) and trismus release (n = 12; 32.4%). For the eight trismus-release patients where mouth opening was documented at admission, all had a mouth opening of 0–20 mm at follow-up. All patients reported that the surgery had improved their quality of life. Conclusions Following their last surgical intervention, noma patients do experience some improvements in their quality of life, but debilitating long-term sequelae persist.

Lao Noma Survivors: A Case Series, 2002–2020

“…These findings are mirrored in two Ethiopian studies 28,29 and a Nigerian study. 5 Our study has shown that the survivors of noma in Laos waited decades before being surgically treated, a finding similar to an Ethiopian study in which the median time from onset of symptoms to access to surgical care was 18 years. 28 These decades of suffering from facial disfigurement during childhood and adolescence frequently lead to stigma resulting in social isolation, excessive questions about the survivors' physical appearance, bullying, and selfconsciousness.…”

“…4 Noma survivors suffer from functional and cosmetic problems, often leading to social exclusion and lack of opportunities from a young age. 3,5 Surgical rehabilitation for these patients is challenging, expensive, and often difficult to access or unavailable in endemic countries. 6 The majority of published literature on noma are case reports, case series, or retrospective studies, mostly from low-income countries in Africa.…”

Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021)

“…The aesthetic and functional sequelae of noma are compounded by the psychological impacts of the disease, not only on the patient, but also on family members and caretakers. Studies have reported that noma has led to mental health issues due to the social isolation and shunning of survivors and their families, bullying, a lack of access to education, difficulties finding jobs, and limited marital prospects [ 16 , 102 , 141 , 156 , 163 , 169 – 172 ].…”

“…If the patient survives the acute illness, they can live into adulthood but often require extensive reconstructive surgery and intensive physiotherapy to improve the resulting structural and functional defects [ 174 ] that often require a number of surgical treatments [ 137 ]. Studies have highlighted the fact that the time between acute illness and surgical care can be decades [ 136 , 141 , 144 ]. The clinical manifestation of each noma case is unique, and as such, the surgical procedures used to treat each noma case differ [ 15 , 39 , 42 , 74 , 102 , 115 – 117 , 145 , 148 ].…”

“…This is mostly due to the remote locations of the home villages of patients and difficulties in accessing health care facilities [ 13 , 14 , 113 ]. However, there have been evaluations of noma survivors after surgery which have shown that surgical treatment for noma survivors greatly improves their quality of life, even if functional improvements (specifically mouth opening) are not pronounced [ 14 , 102 , 136 , 141 , 156 ].The extent of long-term sequelae and their impact on quality of life of noma patients depends on the severity of the disease at initial presentation, efficacy of antibiotic treatment, wound debridement and the facial structures affected [ 91 , 92 , 96 , 97 ]. It was noted that a validated, standardized noma patient-reported outcome measurement tool would be helpful in standardizing outcome reporting after surgical treatment [ 136 , 141 , 175 ].…”