1/9. Noma: report of a case resulting in bony ankylosis of the maxilla and mandible.Noma, or cancrum oris, has been described as a gangrenous infection of the soft and hard tissues of the oronasal region. Prior to the advent of antibiotics the disease was commonly fatal. Now many survive the acute phase of the disease and present the surgeon with formidable problems of repair. This is a report of a presumed case of noma that resulted in bony ankylosis of the maxilla and mandible. Three-dimensional shaded surface CT reconstruction images were especially useful in demonstrating the architecture of the abnormal bone.- - - - - - - - - - ranking = 1keywords = mandible (Clic here for more details about this article) |
2/9. Cancrum oris: its incidence and treatment in Enugu, nigeria.Three Nigerian African patients (two boys aged 5 and 14 and one woman aged 28) with cancrum oris (noma) were seen over a period of 10 years at the maxillofacial unit of the University of nigeria teaching Hospital, Enugu. All three were from lower socioeconomic groups, and were treated with penicillin and metronidazole. The few patients that we saw (three in 10 years) contrasts with the much larger number of patients seen at the maxillofacial unit of the Ahmadu Bello University teaching Hospital, Kaduna, Northern nigeria (140 in 4 years) and University College Hospital, Ibadan, Western nigeria (250 in 3 years). Nutritional cultures differ in these areas, and I suggest that the more balanced diet of the Eastern Nigerians may be one of the reasons for this difference. poverty is the single most important risk factor, and preventive measures are necessary.- - - - - - - - - - ranking = 0.0034718564550351keywords = lower (Clic here for more details about this article) |
3/9. Noma (cancrum oris): case report in a 4-year-old hiv-positive South African child.Cancrum oris (noma) is a gangrenous infection that develops in the mouth and spreads rapidly to other parts of the face. The disease occurs mostly in conditions of poverty, poor hygiene and malnutrition. In sub-Saharan africa the frequency in several countries is estimated to be 1-7 cases per 1,000 population, and as many as 12 cases per 1,000 in the most affected communities. About 90% of these children die without receiving any care, yet the disease can, and should, be prevented. With increasing numbers of children who are malnourished and who have compromised immune systems (compounded by the hiv pandemic) the prevalence of conditions such as noma is likely to increase. Among the earliest features of noma are excessive salivation, marked fetor oris, facial oedema and a greyish-black discolouration of the skin in the affected area. This devastating gangrenous lesion may involve the cheek, the chin, the infra-orbital margin, palate, nose, antrum and virtually any part of the face. This report describes a 4-year-old hiv-positive African girl, who was abandoned, discharged from the plastics Unit and now lives in a child care sanctuary. Little is known about her history prior to her arrival at the home a few weeks previously. The clinical examination revealed a delay in growth and physical development equivalent to that of a 2-year-old child. The left cheek had a perforating ulcer in a healing phase. The perforation, about 1 cm in diameter, was surrounded by oedematous tissues showing a mild to moderate erythema. The peripheral oedema extended to the lower palpebral, the upper labial, left labial commissural, mandibular and pre-parotid regions. Submental, submandibular and cervical lymph nodes were mildly painful upon palpation. The child was not pyretic. The intra-oral examination revealed the features of acute necrotising gingivitis (ANG). ANG was generalised and showed classic interdental crater-like ulcers covered with whitish debris. halitosis was pronounced. Examination of the second quadrant revealed a large ulcer extending from the distal aspect of the deciduous canine to the distal aspect of the second deciduous molar. The adjacent palatal mucosa was severely oedematous. The alveolar bone supporting the first and the second molars was completely exposed to the fundus of the vestibulum. It was not possible to obtain intraoral photographs or radiographs. chlorhexidine gluconate (0.2% solution) and metronidazole tablets, 200 mg twice daily for 15 days were prescribed. The child was seen every alternate day for 10 days and her condition improved rapidly. halitosis had subsided. She was then referred to the Johannesburg Hospital for further treatment under general anaesthesia. The proposed treatment plan was as follows: removal of dental accretions and polishing of all teeth, extraction of the left maxillary teeth supported by non-vital bone, resection of the necrotic bone in the left maxilla and reconstructive surgery in the left cheek.- - - - - - - - - - ranking = 0.0034718564550351keywords = lower (Clic here for more details about this article) |
4/9. Noma: experiences with a microvascular approach under West African conditions.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.- - - - - - - - - - ranking = 0.2keywords = mandible (Clic here for more details about this article) |
5/9. Submental intubation for cancrum oris: a case report.Cancrum oris (Noma) is a devastating gangrenous disease that leads to severe tissue destruction in the face. We describe the anesthetic management of a 12-year-old girl with cancrum oris sequelae in a Rural Secondary level Hospital in Central india (Padhar Hospital). She presented with a large defect in her upper lip on the left side that extended into the columella and the floor of the left nostril. She was scheduled to undergo reconstructive surgery and the surgeons planned to use an Abbe flap based on the lower lip. For this, access to both the mouth and the nose was required. We considered a tracheostomy but decided to attempt the submental route for orotracheal intubation. Following intravenous induction the patient's trachea was intubated with a cuffed oral tracheal tube. This was passed through the submental incision and then reconnected. The surgery proceeded uneventfully and the patient was extubated before transfer. She made a satisfactory recovery and the submental scar healed without complication or scarring. We describe briefly the features of cancrum oris and review the technique of submental intubation (described in adults with midfacial trauma). The use of submental intubation in children and for cancrum oris sequelae has not been previously reported.- - - - - - - - - - ranking = 0.0034718564550351keywords = lower (Clic here for more details about this article) |
6/9. The surgical treatment of noma.Noma is a gangrenous stomatitis affecting children from developing countries. It may leave dreadful mutilations around the mouth, with amputation of the lips, cheek, nose, lids, maxilla, palate, or mandibula. Reconstruction should take into account the size of the defect, the presence of trismus or constriction of the mandible, the age of the child, and the child's general condition. During the last 3 years, eight patients were treated at the Unit of Plastic and Reconstructive Surgery of the Hopital Cantonal Universitaire. Except in one case, tracheostomy was avoided, thanks to intranasal intubation by fibroscopy. These children, aged 2 to 9 years, underwent 31 general anesthesias and complex reconstructive procedures, including latissimus dorsi musculocutaneous pedunculated and free flaps, cranial flaps with galea, cranial bone and skin grafts, and retroauricular temporal skin flaps. All patients were able to return to africa with dramatic functional and cosmetic improvements. However, satisfactory mouth opening and mandibular function were not always obtained.- - - - - - - - - - ranking = 0.2keywords = mandible (Clic here for more details about this article) |
7/9. Noma.We report a case of noma in a debilitated 71-year-old white man. Predisposing factors included malnutrition, preleukemic syndrome, and occult renal adenocarcinoma. The superior third of the patient's lower lip was destroyed before he died.- - - - - - - - - - ranking = 0.0034718564550351keywords = lower (Clic here for more details about this article) |
8/9. Cancrum oris (noma) in children.Cancrum oris, noma or gangrenous stomatitis is a disease which affects primarily undernourished and immunosuppressed young children. Frequent in underdeveloped countries, it also is seen in rare cases of patients with AIDS and leukemia in America and in europe. Once fatal, the disease is now better understood and today the repair of its terrible sequels is looked upon as a great surgical challenge. This paper reports a case of noma in a 3-year-old black African female admitted to this Service. In an already advanced stage of this illness with severe sequelae, she presented with partial amputation of the lips (upper and lower), right cheek, right side of the nose and maxilla. The choice of treatment of the infected area and eventual reconstruction is discussed.- - - - - - - - - - ranking = 0.0034718564550351keywords = lower (Clic here for more details about this article) |
9/9. Total loss of upper and lower lips: challenges in reconstruction.A 2-year-old girl lost both lips after an aggressive attack of noma (gangrenous stomatitis). After an unsuccessful attempt to reconstruct her upper lip, a bipedicled chin flap was used to reconstruct both lips. The cosmetic result was good and the functional result was acceptable.- - - - - - - - - - ranking = 0.01388742582014keywords = lower (Clic here for more details about this article) |