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Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia

Noma is an infectious disease affecting mostly children aged 0–10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa’s Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from th...

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Autores principales: Rakhorst, Hinne A., Gresnigt, Tom M., van Kooten, Oscar, Nishikawa, Hiroshi, Fourie, Leroux, Mizen, Kelvin D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988273/
https://www.ncbi.nlm.nih.gov/pubmed/36891565
http://dx.doi.org/10.1097/GOX.0000000000004844
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author Rakhorst, Hinne A.
Gresnigt, Tom M.
van Kooten, Oscar
Nishikawa, Hiroshi
Fourie, Leroux
Mizen, Kelvin D.
author_facet Rakhorst, Hinne A.
Gresnigt, Tom M.
van Kooten, Oscar
Nishikawa, Hiroshi
Fourie, Leroux
Mizen, Kelvin D.
author_sort Rakhorst, Hinne A.
collection PubMed
description Noma is an infectious disease affecting mostly children aged 0–10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa’s Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from the gums and progressively expanding into the cheek, nose, or eye regions. In an estimated 90% of cases, the disease is lethal as a result of systemic sepsis. For survivors, typical results are extensive defects of the cheek, nose, and periorbital and perioral regions. Due to the defects, extensive scarring is common, which leads to secondary problems such as growth alterations in an infant’s skeleton due to inhibition and restraint of growth resulting typically in cicatricial skeletal hypoplasia. Other sequelae include trismus, partially caused by scarring or complete fusion between maxilla/zygomatic arch and mandible. The resulting overall disfiguring facial appearance results in patients being disabled and socially isolated. METHODS: Facing Africa is a UK-based non-governmental organization that treats the secondary problems of Ethiopian noma survivors. Operations are performed in Addis Ababa by a visiting expert team. Postoperatively, patients are seen annually for years after the surgery. RESULTS: This article discusses basic principles, goals, and a practical surgical algorithm for operating on lip, cheek, and oral defects, based on 210 noma patients who were operated on in Ethiopia over a period of 11 years. CONCLUSIONS: The suggested algorithm has proven to work for the Facing Africa team members and is considered shareware for all surgeons to use and benefit from.
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spelling pubmed-99882732023-03-07 Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia Rakhorst, Hinne A. Gresnigt, Tom M. van Kooten, Oscar Nishikawa, Hiroshi Fourie, Leroux Mizen, Kelvin D. Plast Reconstr Surg Glob Open Reconstructive Noma is an infectious disease affecting mostly children aged 0–10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa’s Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from the gums and progressively expanding into the cheek, nose, or eye regions. In an estimated 90% of cases, the disease is lethal as a result of systemic sepsis. For survivors, typical results are extensive defects of the cheek, nose, and periorbital and perioral regions. Due to the defects, extensive scarring is common, which leads to secondary problems such as growth alterations in an infant’s skeleton due to inhibition and restraint of growth resulting typically in cicatricial skeletal hypoplasia. Other sequelae include trismus, partially caused by scarring or complete fusion between maxilla/zygomatic arch and mandible. The resulting overall disfiguring facial appearance results in patients being disabled and socially isolated. METHODS: Facing Africa is a UK-based non-governmental organization that treats the secondary problems of Ethiopian noma survivors. Operations are performed in Addis Ababa by a visiting expert team. Postoperatively, patients are seen annually for years after the surgery. RESULTS: This article discusses basic principles, goals, and a practical surgical algorithm for operating on lip, cheek, and oral defects, based on 210 noma patients who were operated on in Ethiopia over a period of 11 years. CONCLUSIONS: The suggested algorithm has proven to work for the Facing Africa team members and is considered shareware for all surgeons to use and benefit from. Lippincott Williams & Wilkins 2023-03-06 /pmc/articles/PMC9988273/ /pubmed/36891565 http://dx.doi.org/10.1097/GOX.0000000000004844 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Reconstructive
Rakhorst, Hinne A.
Gresnigt, Tom M.
van Kooten, Oscar
Nishikawa, Hiroshi
Fourie, Leroux
Mizen, Kelvin D.
Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia
title Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia
title_full Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia
title_fullStr Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia
title_full_unstemmed Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia
title_short Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia
title_sort reconstruction of noma sequelae: a surgical treatment algorithm developed from lessons from 210 cases in ethiopia
topic Reconstructive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988273/
https://www.ncbi.nlm.nih.gov/pubmed/36891565
http://dx.doi.org/10.1097/GOX.0000000000004844
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