Management of 159 cases of acute cancrum oris: Our experience at the noma children hospital, Sokoto

Abstract

Background: Cancrum oris (Noma) is a rapidly progressive gangrenous infection of the oral cavity and its surrounding structures, which typically results in destruction of both soft and hard tissues. It requires urgent intervention, especially while still in the acute phase. We present an overview of our experience in the management of acute cancrum oris at the Noma children hospital, which is a regional referral center for such cases in Nigeria. Materials and Methods: This was a retrospective study of 159 patients managed for acute cancrum oris at the Noma children hospital, Sokoto, Nigeria. Early recognition of the disease, baseline investigations, identification of underlying disease/diseases, resuscitation of the patient, and institution of specific treatment were done. Results: The age range was 1–33 years with a mean (±standard deviation [SD]) of 3.5 (3.23) years. The male:female ratio was 1:1.2. Comorbidities were observed in 148 (93.1%) patients. The most commonly seen comorbidities observed were measles and protein–energy malnutrition, which were seen in 75 (47.2%) and 67 (42.1%) cases, respectively. The mean (±SD) hemoglobin of 8.59 (±2.9) g/dl and 11.38 (±1.5) g/dl were recorded on admission and at discharge, respectively. Leukocytosis of >12,000 cells/mm3 was observed in all patients. The electrolyte urea/creatine results were generally within normal range, while serum urea was raised in 52 (32.7%) patients. The duration of admission was for an average of 13 days. A mortality rate of 18.2% was observed. Conclusion: Acute cancrum oris requires urgent management. For successful management, patients should be evaluated for underlying diseases and systemic causes of immunosuppression.