Dr.

Supreet Singh Nayyar, AFMC

2012

Noma / Cancrum Oris / Gangrenous Stomatitis

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Introduction A gangrenous disease leading to tissue destruction of the face, especially the mouth and cheek Noma is a rapidly progressive, polymicrobial, opportunistic infection that occurs during periods of compromised immune function

Epidemiology WHO o Developed countries Negligible presence except occasional HIV case o Rest of world Prevalence 500,000 Global yearly incidence to be approximately 140,000, of which 100,000 are between 1 and 7 years old and living in subSaharan Africa High morbidity and mortality Mainly affects children under the age of twelve in Africa Also known to be present in Asia and some countries of South America Estimates claim that 80 - 90% of noma cases die from the disease

History Similar disease mentioned by Hippocrates & Galen Noma was observed in Nazi concentration camps in World War II, and was studied by Nazi physician Josef Mengele (after these cases were referred to him by a jailed Czek inmate doctor)

Aetiology Mainly o Fusiform bacteria Fusobacterium necrophorum o Prevotella intermedia Others o Staphylococcus aureus o nonhemolytic Streptococcus spp o Borrelia vincentii o Porphyromonas gingivalis o Treponema denticola o Malnutrition o Dehydration o Poor oral hygiene www.nayyarENT.com
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Predisposing factors

Dr. Supreet Singh Nayyar, AFMC

2012

o o o o o o

Poor sanitation Unsafe drinking water Proximity to unkempt livestock Malignancy An immunodeficiency disorder, including AIDS Recent illness o Measles o Herpes simplex o Chicken pox o Scarlet fever o Malaria o Tuberculosis o Gastroenteritis o Bronchopneumonia

Pathophysiolgy A gangrenous infection Able to spread through anatomic barriers such as muscle, fascia Rapid destruction of mouth areas

Clincal presentation Mucous membranes of mouth develop ulcers Rapid, painless tissue degeneration Can degrade tissues of the bones in the face Noma pudenda can also cause tissue damage to the genitals

Treatment To halt progression o Antibiotics o Good nutrition o Oral care & hygiene However, its physical effects are permanent and may require reconstructive plastic surgery to repair Reconstruction is usually very challenging and it should be delayed until full recovery (usually about one year following initial intervention)

NOMA NGOs Children and other noma survivors in Africa are helped by a few international charitable organizationssuch as Facing Africa (a UK registered charity that helps Ethiopian sufferers) There is one dedicated noma hospital in Nigeria, the Noma Children Hospital Sokoto, staffed by resident and visiting medical teams
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Dr. Supreet Singh Nayyar, AFMC

2012

In other countries, like Ethiopia, international charities work in collaboration with the local health care system to provide complex reconstructive surgery which can give back facial functions such as eating, speaking and smiling Teams of volunteer medics coming from abroad are often needed to support the local capacity to address the most severe cases, which can be extremely challenging even for senior maxillofacial surgeons On 10 June 2010 the work of such volunteer surgeons was featured in a UK BBC documentary presented by Ben Fogle titled 'Make me a new face - Hope for Africa's hidden children'

for more topics, visit www.nayyarENT.com

www.nayyarENT.com