Presence Of Trismus Research Articles

The Surgical Treatment of Noma

Noma is a gangrenous stomatitis affecting children from developing countries. It may leave dreadful mutilations around the mouth, with amputation of the lips, cheek, nose, lids, maxilla, palate, or mandibula. Reconstruction should take into account the size of the defect, the presence of trismus or constriction of the mandible, the age of the child, and the child's general condition. During the last 3 years, eight patients were treated at the Unit of Plastic and Reconstructive Surgery of the Hôpital Cantonal Universitaire. Except in one case, tracheostomy was avoided, thanks to intranasal intubation by fibroscopy. These children, aged 2 to 9 years, underwent 31 general anesthesias and complex reconstructive procedures, including latissimus dorsi musculocutaneous pedunculated and free flaps, cranial flaps with galea, cranial bone and skin grafts, and retroauricular temporal skin flaps. All patients were able to return to Africa with dramatic functional and cosmetic improvements. However, satisfactory mouth opening and mandibular function were not always obtained.

Radiologic Diagnosis

The majority of malignant tumors occurring in the nasopharynx are carcinomas usually of the epidermoid type, either undifferentiated or of varying degree of differentiation. Lymphoepithelioma is now accepted by most authorities as a poorly differentiated variant of epidermoid carcinoma. The diagnosis of nasopharyngeal carcinoma is often made after a long delay when the disease has already become advanced. This is largely because nasopharyngoscopy is a difficult procedure except in the hands of the expert. It is not possible to perform this procedure in the presence of trismus (not a rare complication resulting from the lateral spread of the carcinoma to the pterygoid muscles), or when there is a hyperactive pharyngeal reflex, in which case general anesthesia is required. Therefore, if a method which offers simplicity of execution and an acceptable degree of reliability in demonstrating nasopharyngeal lesions could be found, it would go a long way to minimize the diagnostic