Showing papers on "Noma published in 2001"

Clinical experience in the treatment of noma sequelae.

Abstract: We report a cohort of 148 African children operated on between 1985 and 2000 for noma sequelae. A total of 440 operations were performed. Lesions included mouth constriction in 70 of 148 cases, and severe bone destruction in 69 of 148 cases. A large proportion of children was transferred to Switzerland for surgical treatment, whereas the others were operated on in local hospitals in Africa. Vascularized calvarium flap was mostly used for bone reconstruction (n = 36). Pedicled latissimus dorsi myocutaneous flap was the preferred strategy for cheek reconstruction (n = 40). Expanded frontal flap was used for nasal reconstruction (n = 18), and pedicled heterolabial flap for lip construction (n = 37). Given the elevated level of recurrence of mouth constriction (extraarticular ankylosis), a minimum of 2 years' follow-up after surgical treatment was considered mandatory. Follow-up was conducted by field nurses from the humanitarian organizations, and a third of the patients were seen directly by our surgical team during special missions to Africa.

[Noma: 'the face of poverty'].

Abstract: Noma (cancrum oris, water cancer) is an orofacial gangrene that may develop in malnutritioned children debilitated by concomitant diseases as measles. It has been hypothesized that the gangrene originates from acute necrotizing gingivitis, common in malnourished children in developing countries. In previous centuries noma was common in the Western world. The affection disappeared when economical progress permitted the poorest to feed their children sufficiently. The yearly incidence of noma in the world is estimated as 140,000. The mortality is +/- 90%. The facial deformities of those who survive noma are generally serious. Beside facial mutilations, oral functions are hampered (trismus, oral incontinence, impaired speech). Both prevention (improved feeding, measles vaccination) as the treatment of those who contract and survive noma are a challenge for the 'global village' of the modern world.

[Noma in children in a hospital environment in Bobo-Dioulasso: epidemiologic, clinical and management aspects].

Abstract: A retrospective study covering ten years (1987-1996) was conducted to assess the epidemiology, clinical features and management of cancrum oris (noma) in children from Burkina Faso. Fifty nine (59) children were admitted with cancrum oris at the paediatrics and maxillo-facial surgery units of Bobo-Dioulasso, the second town of Burkina Faso. The hospital prevalence of noma is 1.5/1000. 81% of the cases were in the 1 to 5 years age group and 58% were females. Predisposing factors include poverty, lack of immunization, malnutrition, bad oral hygiene, measles and parasitic diseases. The cheek was involved in 31% of the cases. Cure was obtained in 80% of patients after medical and surgical treatment. However, many sequels were observed. Post operative outcome is complicated by the children's growth and often results in retractions, recurrence of ulcers or constriction. Psychological and social problems are associated. Management is difficult in our setting because of the lack of information, cost of the treatment and the absence of well-equipped plastic surgery units.

[Noma and HIV infection: apropos of a case at the National Hospital Center in Bobo-Dioulasso (Burkina Faso)].

Abstract: Noma (Cancrum oris) is a gangrenous stomatitis arising from a periodontal infection and leading to severe soft tissue and bone destruction. The pathology involves numerous factors including local thrombosis, vascularitis, necrotizing gingivitis, immunodeficiency, gram negative and anaerobic infection. It is usually a disease of infants and malnourished children in tropical areas often occurring after a debilitating disease like measles. Recently, cases have been reported in adults especially elderly patients or during immunodeficiency states. Reconstructive surgery is often necessary to deal with destruction and sequel but is rarely accessible in developing countries. We report one case of noma (cancrum oris) in an HIV seropositive patient at the National Hospital in Bobo-Dioulasso. The noma was inaugural of AIDS in a 40 years old labourer coming back from Ivory Coast and no major opportunistic infection was associated. The course was fulminant leading to extensive facial gangrene with recurrent bacterial infections. The disease was fatal in this depressive, malnourished and diarrhoeic patient despite local surgical treatment, prolonged antibiotherapy and supportive care. Pathogenic mechanisms, management and preventive issues are discussed.