Orbital apex syndrome secondary to Noma Destruction: A Case Report

Abstract

Purpose To present a case report of orbital apex syndrome secondary to Noma destructive processes. Method A case of 7-year-old child who presented with an ulcerative defect on the left cheek region and left orbital pain with reduced vision in the left eye has been presented. There was a history of cheek swelling, fever and, loss of appetite with a recent history of malaria treatment. Clinical examination revealed a cone shaped buccal ulcerative defect involving both the left outer and inner cheek walls with extension to the dentoalveolar segment, the maxilla and, the posterior palatal region with an observable sequestrum. Ophthalmological examination revealed loss of vision, complete ptosis and, ophthalmoplegia. There was loss of sensation in the frontal and preorbital region and, absolute pupillary defect in the same eye. A clinical diagnosis of orbital apex syndrome secondary to noma destruction was made. Result Management was instituted by a team of maxillofacial surgeons, ophthalmologists and, nutritionists. Antibiotics, serial debridement, and sequestrectomy were the predominant treatments given and there was resolution of the symptoms except persistent ptosis, loss of vision and, ophthalmoplegia. Conclusion Noma is a rapidly progressive disease that is capable of destroying oral and surrounding soft and, hard tissues with serious functional and cosmetic complications. Orbital apex syndrome was seen as a complication in this case report. This reinstates the need for early detection and treatment of noma.