Noma, also known as cancrum oris, is a rapidly progressive gangrenous infection that affects the oral and facial tissues of malnourished children in impoverished regions, particularly in sub-Saharan Africa. The disease typically begins as acute necrotising gingivitis and rapidly progresses to extensive tissue destruction, facial disfigurement, and high mortality if left untreated. This narrative review explores the clinical progression of Noma, its World Health Orgnisation (WHO) classification and simplified staging systems, the pathogenesis involving malnutrition, immunosuppression, and microbial dysbiosis, as well as the polymicrobial nature of the disease. Diagnosis of Noma is primarily clinical, although emerging microbiome-based diagnostic techniques show promise for early detection. Management requires a comprehensive approach that combines early antibiotic therapy, nutritional rehabilitation, wound care, and delayed reconstructive surgery. Preventive strategies include adequate vaccination (particularly against measles), community-based oral health education, and improvements in Water, Sanitation, and Hygiene (WASH) initiatives. Strengthening local healthcare infrastructure and establishing sustainable surgical programmes are essential for long-term control and rehabilitation of Noma. Addressing the socio-economic determinants of Noma through holistic public health efforts remains crucial for reducing its burden and achieving global eradication.

Facial paralysis can negatively impact quality of life (QoL), but its impact compared to other groups is unknown. To compare QoL domain scores of facial paralysis patients with the general population, patients with burns, and patients referred for medical-psychological counselling; evaluate associations with demographic and disease-related factors. Medical data of facial paralysis patients were extracted from electronic health records. Participants completed the RAND-36. Mean domain scores between samples were compared using t-tests with Bonferroni correction. Associations with demographic and disease-related variables were assessed using t-tests and Pearson correlations. Among 177 participants (mean age 58.1 years, 63% female), QoL scores were >5 points (all p < 0.05) lower than the general population across all QoL domains except "Physical function" and "Pain." Scores were comparable to patients with burns and better than individuals referred to medical psychology (difference >5 points, all p < 0.05). Younger age was associated with lower mental health (r = 0.16, p = 0.032) and vitality (r = 0.17, p = 0.026). Females had significantly worse mental health (ES = -0.32), vitality (ES = -0.32), and general health (ES = -0.38). Facial paralysis is associated with reduced QoL on physical, psychological, and social domains. Clinicians should acknowledge this impact and refer patients to specialists in coping with facial disfigurement when appropriate.

In the late nineteenth century, the popularity of cycling prompted a series of medicalised warnings, particularly for women. Among these was "bicycle face": a "nervous condition" attributed to a constant state of stress from attempting to balance a bicycle combined with prolonged facial grimacing, which was believed to result in nervous exhaustion and facial disfigurement. In New Zealand, media coverage peaked between 1895 and 1897, framing it as a threat to women's health, beauty and morals. Related conditions included "cyclemania", "bicycle stoop", "bicycle hump", "bicycle walk" and "bicycle heart". These designations reflected gender norms and anxieties over female independence, rather than medical evidence. The episode mirrors a broader historical pattern in which emerging technologies have triggered dubious health fears which parallel contemporary concerns over the safety of mobile phones, 5G towers and wind turbines. The authors explore the cultural and medical construction of "bicycle face" during the late nineteenth and early twentieth centuries, showing how a small number of rogue physicians used the media to amplify unfounded fears, implanting them into the public consciousness. The historical tendency for health practitioners to superimpose prevailing attitudes and beliefs onto health risks linked to new technologies highlights the need for evidence-based evaluations and vigilance against allowing cultural anxieties to masquerade as novel medical conditions.

Background: Orofacial Burkitt lymphoma, a major manifestation of the endemic variant of Burkitt lymphoma in African children, has historically posed serious health challenges in sub-Saharan Africa due to its aggressive nature and potential for facial disfigurement. Fortunately, both its incidence and prevalence have decreased recently. Objectives: To investigate the pattern of Burkitt's lymphoma distribution in the orofacial region and treatment outcomes. Methods: This retrospective review spans 15 years (2007-2021) and examines cases of Burkitt’s lymphoma at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria. The study included records of 62 cases presenting with orofacial Burkitt's lymphoma and complete clinical, histological, and/or cytological data. Results: There was a consistent decline in incidence over the study period. Most patients (51, 82.3%) were aged 1–10 years, with a male-to-female ratio of 2.7:1. The maxilla was the most frequently affected site (42.0%), and the majority (77.4%) presented with advanced-stage disease. Overall, 58.6% achieved remission, with a correlation (p &lt; 0.001) between the number of chemotherapy cycles received and treatment outcomes. Conclusion: Despite challenges, orofacial Burkitt's lymphoma remains treatable. This study highlights the importance of treatment adherence and completion of the recommended chemotherapy courses.

Full facial vascularized composite allotransplantation (VCA) offers a reconstructive option for patients with severe facial disfigurement who cannot be treated with conventional methods. This article details a surgical protocol for donor procurement of a full facial allograft, focusing on soft tissue with limited bony harvest restricted to the nasal framework, and emphasizes key anatomical landmarks and technical considerations for safe and efficient harvest. The procedure involves dissection of the entire facial soft tissues while preserving the external carotid artery, internal jugular veins and subsequent thyro-linguofacial, and branches of the facial and maxillary nerves to maximize pedicle length for later neurorrhaphy. The protocol describes systematic exposure of the vascular pedicles at their origin in the neck, subperiosteal elevation of the scalp, identification and division of the supraorbital and infraorbital nerves, and preparation of the facial nerve at its root to achieve optimal length. Strategies to minimize ischemia time and ensure allograft integrity are highlighted. This article provides a comprehensive visual guide to the procurement phase of a full soft tissue face allograft and aims to standardize the technique for research application and surgical training in advanced vascularized composite allotransplantation.

Faces are central to human interaction, serving as primary sources of identity, emotional cues, and social judgments. Facial attractiveness is strongly linked to perceptions of trustworthiness and moral goodness, leading to preferential treatment across education, employment, and legal contexts. Deviations from facial norms-such as asymmetry or visible differences-are, by contrast, often associated with negative traits, social avoidance, and dehumanisation. Across cultures and centuries, deliberate facial disfiguration has been used as a form of punishment for perceived moral or legal transgressions. Evidence from ancient Egypt, Mediaeval Europe, and early modern legislation, as well as modern acid attacks, indicates that intentional facial disfiguration has long served as a means of ongoing punishment through humiliation and identity disruption. Motivations for targeting the face may be rooted in its central role in identity, beauty, symmetry, and symbolic purity. Despite contemporary legal efforts to curb acid attacks and related violence, legislation specifically addressing intentional facial disfiguration remains limited. Modern psychological research confirms that acquiring a facial difference can severely impact quality of life, social functioning, and identity. This paper synthesises historical, cultural, and psychological perspectives on punitive facial disfiguration, highlighting its enduring role as a mechanism of social control. Future research should examine perpetrators' decision-making, possible differences between different types of facial disfiguration, and the perceptual and emotional consequences of different facial injuries to inform prevention strategies and improve support for victims.

Face transplantation (FT) offers a reconstructive option for patients with severe facial disfigurements by restoring both function and appearance. Aesthetic outcomes, which are crucial to psychological well-being and social reintegration, have historically been evaluated subjectively. This study introduces the AI Research Metrics Model (CAARISMA ® ARMM), a machine learning-based medical device designed to objectively assess aesthetic outcomes in FT patients. Overall, 14 FT patients were analyzed using CAARISMA ® ARMM, which evaluates 3 key aesthetic indices: the Facial Youthfulness Index (FYI), Facial Aesthetic Index (FAI), and Skin Quality Index (SQI). Preoperative, postoperative, and pre-trauma images were processed to assess improvements in facial aesthetics. Statistical analysis was performed to compare changes in these indices across the different time points. Postoperative scores for FYI, FAI, and SQI were significantly higher than preoperative scores (p < 0.0001), indicating substantial aesthetic improvements. No significant differences were found between postoperative and pre-trauma images, suggesting that FT can effectively restore a patient's pre-injury appearance. Aesthetic improvements were consistent across different age and gender groups, with no notable disparities in outcomes. CAARISMA ® ARMM offers a reliable and objective framework for objectifying aesthetic outcomes following FT, allowing for more standardized assessments. This medical device can potentially improve patient-surgeon communication, enhance surgical planning, and serve as a benchmark for evaluating long-term aesthetic success in FT patients. Future research should focus on expanding CAARISMA ® ARMM's application to larger and more diverse patient populations.

Facial disfigurements involving the nose can severely impact an individual’s psychological well-being and social interactions. Nasal defects, whether congenital or acquired, pose significant challenges for rehabilitation due to their central facial location and aesthetic importance. This case report presents the maxillofacial rehabilitation of a 57-year-old female patient with a total nasal defect resulting from trauma sustained 25 years prior. The patient’s existing prosthesis exhibited discoloration, rigidity, and poor marginal adaptation. A new nasal prosthesis was fabricated using medical-grade silicone for enhanced esthetics, comfort, and durability. The prosthesis was retained using spectacles to provide mechanical stability and conceal prosthetic margins. The rehabilitation process involved precise impression making, wax pattern sculpting, color matching with intrinsic pigmentation, and careful adaptation to the patient’s facial contours. The patient reported high satisfaction with the prosthesis’ color match, retention, and comfort, leading to improved confidence and quality of life. This case highlights the clinical effectiveness of silicone prostheses in restoring facial form and function and underscores the importance of periodic evaluation and replacement for sustained success. Advancements in materials and fabrication techniques continue to enhance the outcomes of maxillofacial rehabilitation for patients with nasal defects.

Noma is a severe, rapidly progressing necrotizing infection that predominantly affects children in resource-limited settings and can lead to devastating facial disfigurement. Despite its burden, limited data exist on its clinical profile and surgical outcomes in Ethiopia. We conducted a retrospective study of 103 noma survivors treated during the Facing Africa surgical missions in Ethiopia from 2007 to 2020. Data were collected on sociodemographics, clinical presentation, anatomical involvement, surgical procedures, complications, and follow-up outcomes. Descriptive statistics were used, and comparisons were made with regional data. Of the 103 patients, 51.5% were men, with a mean age of 27.4 years. Most (74.8%) lived in rural areas, and more than 60% lacked formal education. Common clinical issues included eating difficulties (77%), speech challenges (54.4%), and trismus (38.8%). Submental flap (49.5%) and radial forearm free flap (20.4%) were the most common procedures. Postoperative complications included wound infection (22.3%) and flap failure (16.5%). Secondary procedures such as scar revision (66%) and commissuroplasty (32%) were frequently needed. Noma continues to disproportionately affect vulnerable populations in Ethiopia. Although surgical reconstruction is effective, high complication rates and the need for multiple surgical procedures underscore the importance of comprehensive long-term care, including rehabilitation and psychological support.

A 24-year-old patient with B-cell acute lymphoblastic leukemia underwent high-dose chemotherapy followed by allogeneic bone marrow transplantation (BMT) according to the BMT 2000 protocol. The post-transplant course was complicated by the development of severe, Grade 4 graft-versus-host disease (GVHD), with multiorgan involvement and significant facial disfigurement. This condition not only posed life-threatening challenges but also led to profound psychological and social consequences. Management required a comprehensive, multidisciplinary approach combining long-term immunosuppressive therapy to control immune activity, advanced cosmetic surgical interventions to restore facial form, and supportive care aimed at preserving organ function. Over the course of 5 years, the patient gradually stabilized and reached an asymptomatic state with ongoing immunosuppressive therapy, showing no acute adverse effects. This case emphasizes the complexity of treating advanced GVHD following BMT and highlights the importance of integrating immunologic, cosmetic, and supportive strategies. Sustained multidisciplinary care and long-term follow-up are critical to improving both survival and quality of life in such patients.

Primary intraosseous hemangioma of the orbit is a rare, but typically benign bone tumor, with insidious onset and unclear etiology. The primary surgical objectives encompassed complete lesion resection with immediate reconstruction of the osseous defect to achieve optimal functional and aesthetic restoration. We present the case of a 72-year-old male patient who underwent complete surgical excision with subsequent orbital reconstruction for a progressively enlarging infraorbital mass that caused significant cosmetic disfigurement. Histopathological examination confirmed the diagnosis of hemangioma. During follow-up, the patient demonstrated satisfactory wound healing with maintained midfacial projection and unchanged visual fields compared to preoperative status. For patients with intraosseous orbital hemangiomas, the primary concern is facial disfigurement. Surgical resection followed by reconstruction remains the treatment of choice, while the pathogenesis and alternative therapeutic approaches warrant further investigation.We present a case of orbital intraosseous hemangioma to contribute insights into this scarcely documented pathology.

Background: Surgical resection is the primary treatment for ameloblastoma but often causes facial disfigurement and complications. Conservative management of unicystic ameloblastoma (UA) may prevent these issues. Clinicians should note that combining marsupialization, enucleation, and Carnoys solution adjuvant therapy restores jawbone health, prevents complications, and improves patients quality of life. Presentation: Two pediatric casesa 13-year-old boy with a 3-month right mandibular ramus swelling and an 11-year-old boy with a 5-month anterior mandibular swellingpresented at General Hospital Ifako-Ijaiye. Clinical and investigative findings confirmed unicystic mural ameloblastoma. Intervention: Both underwent marsupialization followed by enucleation with Carnoys solution. Preoperative orthopantomograms showed unilocular radiolucent lesions; postoperative imaging revealed restored bony trabeculae. Outcome: Successful treatment with no recurrence after one year (ongoing monitoring). There was no clinical or radiographic evidence of recurrence at 1-year follow-up. Planned surveillance per IAOMS guidelines (≥5 years for mural UA)" Conclusion: Conservative UA management with regular follow-up prevents facial disfigurement and complications associated with resection, improving quality of life. These are Nigeria’s first documented pediatric UA cases. Keywords: unicystic ameloblastoma, marsupialization, enucleation, Carnoys solution.

Objective: The objective of this study was to explore the evolving role of Functional Endoscopic Sinus Surgery (FESS) - the gold standard in the treatment of chronic rhinosinusitis and other sinus diseases. Advances in diagnostic imaging, surgical instruments, and navigation systems have significantly improved the safety and efficacy of this technique. This study provides an overview of the FESS technique, and its expanding indications - application in the treatment of selected sinus tumors, such as inverted papilloma, juvenile nasopharyngeal angiofibroma (JNA), and osteomas. Methods: A narrative review of the literature was conducted, focusing on the development of FESS, its surgical technique, safety profile, and clinical outcomes. Special attention was given to its comparison with traditional open approaches in both inflammatory and neoplastic conditions of the sinonasal tract. Key Findings: The analysis revealed that technological progress - particularly in diagnostic imaging, surgical instruments, and intraoperative navigation - has significantly improved the precision and safety of FESS. Clinical evidence demonstrates that endoscopic resection of sinonasal tumors often achieves recurrence rates equal to or lower than those associated with open surgery, while minimizing morbidity, hospitalization time, and facial disfigurement. Successful outcomes depend on appropriate patient selection, meticulous preoperative planning, and the surgeon’s expertise. Conclusions: Functional Endoscopic Sinus Surgery is a safe and effective modality for treating a wide range of sinonasal diseases, including chronic rhinosinusitis and selected benign tumors. With proper patient selection, preoperative planning, and surgical expertise, FESS offers substantial benefits over traditional open approaches, including reduced morbidity and improved recovery. Continued technological advancements and long-term outcome studies will further refine its role in comprehensive sinonasal care.

Individuals with facial disfigurements, an estimated 10 million people in Europe (1:5 incidence), frequently encounter significant social and psychological challenges, including pervasive discrimination and stigmatization, which profoundly impact their educational and particularly their employment opportunities. This article presents a sociological analysis, grounded in theories of stigma, social exclusion, intersectionality, and the social model of disability, to underpin the development of a targeted training initiative for health professionals and the NGO sector in seven European countries. Utilizing a qualitative methodology, semi-structured interviews were conducted with a total of 108 professionals across 8 European countries: the Netherlands, Sweden, Romania, Serbia, Cyprus, Greece, Norway and Spain. The study explores professional perceptions of the disadvantages faced by individuals with visible differences, their specific manifestations (e.g., employment barriers, social isolation, negative stereotypes), and the perceived benefits of a targeted training intervention, as well as preferred formats of specialized training. Research indicates a strong, international consensus regarding widespread discrimination and a significant readiness among professionals to engage in training that improves understanding, communication skills, and the capacity to foster inclusive environments for those working with facial disfigurements. These insights are crucial for tailoring effective, context-sensitive interventions in the mentioned countries, addressing both universal and unique intersectional challenges faced by individuals with facial disfigurements.

Unilateral mandibular discontinuity from surgery or trauma causes deviation of the mandible toward the defect, which leads to loss of occlusion on the normal side. These resections also impair speech, swallowing, and salivary control, and result in facial asymmetry and disfigurement. A key objective of treatment is to restore acceptable occlusal function. In edentulous patients, maxillomandibular fixation or stabilizing projection can be facilitated, whereas in dentate patients, the presence of residual teeth assists in repositioning the mandibular fragments, and this process can be further supported by the use of guidance prostheses. Such prostheses play a crucial role in retraining the mandible after partial mandibulectomy, helping to re-establish functional occlusion and allowing for an earlier shift to a near-normal, definitive restoration. This paper reviews various mandibular guidance prostheses employed in managing mandibular deviation in both edentulous and partially dentulous patients.

Psychiatric morbidities and quality of life among surgically treated noma survivors. Preliminary observations in Nigerian cohorts.

Rationale:Orbital ameloblastoma is a rare benign tumor with metastatic potential, typically exhibiting follicular or plexiform histopathological patterns. Ameloblastoma commonly occurs in the jaws and rarely metastasizes; when it does, the lungs and lymph nodes are the most frequent secondary sites. In the world’s reported literature, there are 32 cases of maxillary ameloblastoma metastasizing to the orbit, with only 4 cases of mandibular ameloblastoma metastasizing to the orbit. The mystery lies in its high recurrence rate and aggressive malignant potential despite being classified as a benign tumor, posing a serious threat to the ocular health and quality of life of patients.Patient concerns:This article reports an unusual case of a female patient who was initially diagnosed with mandibular ameloblastoma 17 years ago. Despite undergoing treatment, the tumor recurred and unusually metastasized to the orbit, resulting in a massive lesion that compressed the tissues surrounding the eyeball. She complained of gradual vision loss in her right eye, redness of the eye, and incomplete eyelid closure.Diagnoses:Magnetic resonance imaging (MRI) scans of the orbit indicated a lesion measuring approximately 5.8 cm*5.1 cm*5.7 cm (centimeter, cm). The clinical diagnosis is recurrent ameloblastoma of the right orbital, with the histopathological subtype being the basal cell type.Interventions:The patient underwent 2 successful partial excisions of the orbital tumor, effectively relieving the compression on the eyeball caused by the tumor.Outcomes:Currently, the 22-month follow-up after the second surgery has shown satisfactory results, with the patient’s visual function being preserved.Lessons:The patient exhibited significant facial disfigurement at the time of presentation to the ophthalmology department, attributable to the large size of the orbital mass. Inadequate awareness of this uncommon pathology may result in misdiagnosis as basal cell carcinoma or other malignant orbital neoplasms. Despite the preservation of visual function, limited understanding of the disease could lead to overly aggressive surgical management. Therefore, this case is reported to provide insights into the diagnosis, management, and prognosis, serving as a reference for clinicians encountering similar presentations.

Facial transplantation (FT), a pioneering vascularized composite allotransplantation procedure since 2005, has transformed reconstructive surgery for severe facial disfigurement caused by trauma, burns, or congenital disabilities. This article synthesizes two decades of global experience, evaluating long-term psychological and functional outcomes from 48 procedures in 46 patients. FT significantly enhances quality of life (QoL), with patients reporting improved self-esteem, reduced depression (e.g., Beck Depression Inventory scores dropping from 16 to 8), and successful social reintegration, including workplace reentry and personal milestones. Functionally, FT restores critical abilities: 100% of cases achieved sensory recovery (thermal/mechanical) within 3–8 months, 76% improved facial expressions, and 93% regained independent breathing. Speech and swallowing often return to near-premorbid levels within 1–2 years. However, challenges persist, including universal acute rejection (reversible), chronic rejection (6% incidence, 14.6% graft loss), and immunosuppression-related risks like infections and malignancies, contributing to 10 patient deaths (21.7%). Ethical debates surround lifelong immunosuppression for a non-life-saving procedure and candidate selection complexities. The absence of FT-specific patient-reported outcome measures (PROMs) hinders standardized assessment. This review underscores the need for refined patient selection, multidisciplinary collaboration, and innovative immunological strategies (e.g., tolerance induction) to minimize risks. Advances in virtual surgical planning and AI-driven monitoring show promise. Continued research and global cooperation are essential to optimize FT’s transformative potential, ensuring sustainable, equitable access to this life-altering intervention.

Maxillectomy defects can result in oroantral communication which leads to significant difficulty in mastication and deglutition, impaired speech, and facial disfigurement. This case report describes the fabrication of a definitive hollow obturator supported by cast ball attachment on a lone standing tooth in an operated case of Hodgkins lymphoma of the maxillary sinus. A lone standing premolar was retained and used effectively as an abutment in this patient with compromised basal seat. The definitive obturator significantly enhanced the patient’s recovery by improving chewing efficiency, refining speech clarity, and boosting overall quality of life. Keywords: maxillofacial prosthodontics, maxillary defects, Semi-Precision attachment, hollow bulb obturator, lost salt technique,

Facial paralysis significantly impacts patients' quality of life, primarily through facial asymmetry and disfigurement, which affect psychosocial well-being. While dynamic reanimation remains the ideal approach, many patients—particularly older adults and those with long-standing or irreversible paralysis—benefit from static procedures such as rhytidectomy. This review examines the role of rhytidectomy as an adjunctive, primarily aesthetic intervention aimed at addressing secondary deformities, including facial soft tissue ptosis and asymmetry. Evidence indicates that static facelift procedures can produce substantial improvements in facial symmetry, patient satisfaction, and quality-of-life metrics, especially in elderly populations unsuitable for dynamic techniques. Though rare, the risk of nerve injury must be considered, but overall, rhytidectomy is a safe and effective option for enhancing facial appearance and psychosocial well-being in appropriately selected patients. These findings support the integration of static facial procedures into comprehensive management strategies for facial paralysis, emphasizing their value in achieving meaningful aesthetic and functional outcomes.