Noma is a quickly spreading orofacial gangrene occurring in malnourished children weakened by disease. In the past common in Europe the disease is still present in (mainly) Africa. The World Health Organization estimates that 130,000 children die worldwide each year as a result of noma. The aetiology and pathogenesis of the affection is not well defined. A clear correlation exists between noma and the occurrence of extreme poverty, malnutrition, the presence of necrotizing gingivitis and concomitant debilitating diseases like measles and HIV. However the microbiological and infectious pathways that lead to noma have not been explored thoroughly yet. The onset is an intraoral ulcer that expands quickly to severe swelling in the face, often resulting in necrosis of parts of the face (lips, cheek, nose, maxilla) if not sepsis and death. The mortality rate of noma is estimated to be around 90%. Patients who survive noma often end up with facial disfigurement leading to social ostracism and problems with speech and eating. Surgical rehabilitation is directed to reconstruction of an acceptable face. Half of these patients have an impaired opening of the mouth due to fibrotic trismus or an ankylosis of the mandible. Release often gives disappointing results.
Noma, an orofacial gangrene with the challenge of trismus and ankylosis of the mandible: an overview
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