Osteoplastic reconstruction techniques in noma surgery

Abstract

Noma is the most severe form of infective gangrene of the mouth. It generally begins in the gingival sulcus of children. After infection a gaping hole remains in the face. Shrinking scar tissue leads to extreme disfigurement of the face and restricts jaw movement. Microsurgical reconstruction is mainly performed by revascularized osseous, osteocutaneous, or osteomyocutaneous distant flaps for large oro-maxillo-facial defects since the early 80-ies of the last century. To reflect the subtle special anatomy of the face and skull, complex composite grafts were introduced for reconstruction in 1996. At the same time orthopaedists established the distraction osteogenesis for restoration and rehabilitation of extremities defects which has been modified for usage in craniofacial surgery soon afterwards. As initially pointed out by McCarthy 1992, it (Distraction osteogenesis) has taken craniofacial surgeons out of the field of soft-tissue and hard-tissue construction and into that of tissue engineering and "inductive surgery". This paper reports the clinical application of both methods – the distraction osteogenesis and microsurgical reconstruction with prefabricated composite grafts – to rehabilitate Noma induced defects.