Innovative Techniques in Noma Reconstructive Surgery

Abstract

Noma (orofacial gangrene, necrotizing ulcerative stomatitis, stomatitis gangrenosa, or cancrum oris) is a devastating orofacial gangrene that occurs almost uniquely among children in less developed countries, during the weaning period [5, 6, 10, 11, 37, 38]. The most important risk factors are: poverty, malnutrition, a compromised immune system, poor oral hygiene and a lesion of the gingival mucosal barrier, as well as an unidentified bacterial factor [5]. The disease has an estimated global yearly incidence of 25,600-140,000 cases and a mortality rate of approximately 90% [13]. Patients who survive the acute noma stages generally suffer from its sequelae, including serious facial disfigurement, trismus and ankylosis, oral incontinence, and speech problems. This is why noma has been called “the face of poverty” [10, 26]. The complex facial defects can be classified with the NOITULP system, as proposed by Marck in 1998 [27]. NOITULP is an acronym of Nose, Outer lining, Inner lining, Trismus, Upper lip, Lower lip and Particularities. Every itemis validated and given a score from 0 to 4 (Table 22.1).