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Laryngoscope. 2019 Jan;129(1):96-99. doi: 10.1002/lary.27230. Epub 2018 Sep 8.

Noma surgery.

Shaye DA1,2,3,4, Winters R1,5, Rabbels J1,6, Adentunji AS1,7, Magee A1,8, Vo D1,9.

Author information

1
Doctors Without Borders, Amsterdam, Holland. Noma Project, Sokoto, Nigeria.
2
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
3
Department of Global Health and Social Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
4
Department of Otolaryngology, University Teaching Hospital Kigali, University of Rwanda, College of Medicine & Health Sciences, Kigali, Rwanda.
5
Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, U.S.A.
6
Department of Oral and Maxillofacial Surgery, Katharinen Hospital, Stuttgart, Germany.
7
Children's Noma Hospital, Sokoto State, Nigeria.
8
Department of Anaesthesia and Critical Care, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
9
Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Abstract

OBJECTIVE:

Noma is a devastating and destructive disease of the face for which there is a dearth of information regarding surgical options. Herein, we describe the facial deformities and patient characteristics in a patient population affected by noma and the surgical approaches used in treatment.

METHODS:

Retrospective case series of a Doctors Without Borders (Médecins Sans Frontières) intervention at Sokoto Children's Noma Hospital in northern Nigeria, the highest-volume noma hospital in the world.

RESULTS:

Twenty-two procedures were performed on 18 patients with noma, 44% of whom were children. The majority of patients (n = 10, 55.5%) were made aware of surgical care through a Doctors Without Borders outreach program. Patients' reasons for seeking care included functional (61.1%, n = 11), appearance (61.1%, n = 11), and social stigma (66.7%, n = 12). The majority (83.3%, n = 15) had lip involvement. Four patients (22.2%) underwent staged flap procedures including prelamination, flap delay, or pedicle division. The mean duration of surgical procedure was 87 minutes (range 5-306 minutes). The minor complication rate was 16%. There were no major complications or deaths.

CONCLUSION:

Noma is a mutilating disease of the face that occurs in settings of extreme malnutrition. A total of 55.5% of noma patients were made aware of surgical care through outreach programs. The majority of noma patients seek care to improve function (61.1%) and appearance (61.1%), and to address social stigma (66.7%). A total of 83.3% of noma patients had lip involvement. Facial reconstructive surgeons must rely on principles of congenital, traumatic, and oncologic deformity repair while focusing on safe, reliable procedures for low-resource settings.

LEVEL OF EVIDENCE:

4 Laryngoscope, 129:96-99, 2019.

KEYWORDS:

Doctors Without Borders; Noma; cancrum oris; deltopectoral flap; global surgery; low-resource settings; malnutrition; orofacial gangrene

PMID:
30194753
DOI:
10.1002/lary.27230
[Indexed for MEDLINE]

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