The surgical management of extra-articular ankylosis in noma patients

Rüegg, Eva Meia; Baratti-Mayer, Denise; Jaquinet, A.; Montandon, Denys; Pittet‐Cuénod, Brigitte

doi:10.1016/j.ijom.2018.07.012

Cited by 17 publications

(24 citation statements)

References 23 publications

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“… 12 A similar study with 95 patients from Niger and Burkina Faso reported that after 3 y, the mean mouth opening was 21 mm. 15 Our results were similar to these studies and showed that all patients had a mouth opening of between 0–20 mm at follow-up (median mouth opening of our cohort: 15 mm for those aged ≤15 y; 10 mm for those aged >16 y).…”

Section: Discussionsupporting

confidence: 91%

“…The procedures performed rely on regional flaps and local tissue and are in line with other reported surgical techniques used to treat noma. 6 , 8 , 15 , 18 , 19 , 31 , 32 Other providers have described the use of free flaps 33 , 34 however, given the technical and resource demands of microsurgery, these techniques are not currently utilised at the NCH. The surgical programme instead enlists older but reliable reconstructive techniques that are less risky in this context.…”

Section: Discussionmentioning

confidence: 99%

“…Reported surgical techniques to address the spectrum of noma defects include pedicled supraclavicular flaps for the treatment of large unilateral facial defects, 18 abbe, estlander and fan flaps for the reconstruction of the lips and corner of the mouth, 6 , 19 forehead, deltopectoral, radial forearm and free flaps for the reconstruction of the cheek 6 , 15 and abbe, radial forearm, free, medial forehead and local turnover flaps for the reconstruction of central defects (upper lip and nose). 6 , 8 , 15 Mouth opening is improved by performing bone-bridge excision, sometimes associated with contralateral coronoidectomy. 15 …”

Section: Introductionmentioning

confidence: 99%

“…6 , 8 , 15 Mouth opening is improved by performing bone-bridge excision, sometimes associated with contralateral coronoidectomy. 15 …”

Section: Introductionmentioning

confidence: 99%

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

Farley

Amirtharajah

Winters

et al. 2020

Transactions of the Royal Society of Tropical Medicine and Hygiene

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

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…6 , 8 , 15 Mouth opening is improved by performing bone-bridge excision, sometimes associated with contralateral coronoidectomy. 15 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Farley

Amirtharajah

Winters

et al. 2020

Transactions of the Royal Society of Tropical Medicine and Hygiene

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“…In published work, noma is often classified into two stages (acute and chronic noma 35 36 ) or with the Montandon system (classifies noma according to the location of the defect). 37 The lack of standardisation complicates comparison between different studies. The WHO noma staging system 1 is the most comprehensive to date and includes an early-stage noma definition which is useful as it identifies those at risk of progressing to later stage noma.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of noma in northwest Nigeria

Farley¹,

Oyemakinde

Schuurmans

et al. 2020

BMJ Glob Health

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BackgroundNoma, a rapidly progressing infection of the oral cavity, mainly affects children. The true burden is unknown. This study reports estimated noma prevalence in children in northwest Nigeria.MethodsOral screening was performed on all ≤15 year olds, with caretaker consent, in selected households during this cross-sectional survey. Noma stages were classified using WHO criteria and caretakers answered survey questions. The prevalence of noma was estimated stratified by age group (0–5 and 6–15 years). Factors associated with noma were estimated using logistic regression.ResultsA total of 177 clusters, 3499 households and 7122 children were included. In this sample, 4239 (59.8%) were 0–5 years and 3692 (52.1%) were female. Simple gingivitis was identified in 3.1% (n=181; 95% CI 2.6 to 3.8), acute necrotising gingivitis in 0.1% (n=10; CI 0.1 to 0.3) and oedema in 0.05% (n=3; CI 0.02 to 0.2). No cases of late-stage noma were detected. Multivariable analysis in the group aged 0–5 years showed having a well as the drinking water source (adjusted odds ratio (aOR) 2.1; CI 1.2 to 3.6) and being aged 3–5 years (aOR 3.9; CI 2.1 to 7.8) was associated with being a noma case. In 6–15 year olds, being male (aOR 1.5; CI 1.0 to 2.2) was associated with being a noma case and preparing pap once or more per week (aOR 0.4; CI 0.2 to 0.8) was associated with not having noma. We estimated that 129120 (CI 105294 to 1 52 947) individuals <15 years of age would have any stage of noma at the time of the survey within the two states. Most of these cases (93%; n=120 082) would be children with simple gingivitis.ConclusionsOur study identified a high prevalence of children at risk of developing advanced noma. This disease is important but neglected and therefore merits inclusion in the WHO neglected tropical diseases list.

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Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia

Gebretsadik

2024

Laryngoscope Investig Oto

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IntroductionNoma, 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 MethodsThe research employed a cross‐sectional retrospective review of medical records treated between 2007 and 2019 retrieved from the Facing Africa database.ResultsThe 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.ConclusionThese 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 Evidence5.

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The surgical management of extra-articular ankylosis in noma patients

Cited by 17 publications

References 23 publications

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

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

The prevalence of noma in northwest Nigeria

Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia

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