Noma (Cancrum Oris): A Report of a Case in a Young AIDS Patient with a Review of the Pathogenesis

Noma (cancrum oris) is a mutilating necrotising disease of the orofacial tissues. It affects predominantly debilitated malnourished children, in whom the necrotic process may cause severe damage to mid-facial structures. Its aetiopathogenesis is uncertain, but its course is fulminating, and without...

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Bibliographic Details
Published in:Head & neck pathology (Totowa, N.J.) N.J.), 2013-06, Vol.7 (2), p.188-192
Main Authors: Masipa, J. N., Baloyi, A. M., Khammissa, R. A. G., Altini, M., Lemmer, J., Feller, L.
Format: Article
Language:English
Subjects:
Acquired Immunodeficiency Syndrome - complications
Acquired Immunodeficiency Syndrome - pathology
AIDS-Related Opportunistic Infections - microbiology
AIDS-Related Opportunistic Infections - pathology
Case Report
Child
Child Nutrition Disorders
Dentistry
Face - pathology
Humans
Male
Mandible - pathology
Maxilla - pathology
Medicine
Medicine & Public Health
Necrosis
Noma - etiology
Noma - pathology
Oral and Maxillofacial Surgery
Otorhinolaryngology
Pathology
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Summary:Noma (cancrum oris) is a mutilating necrotising disease of the orofacial tissues. It affects predominantly debilitated malnourished children, in whom the necrotic process may cause severe damage to mid-facial structures. Its aetiopathogenesis is uncertain, but its course is fulminating, and without timely intervention the disease may be fatal. Antibiotic treatment during any stage of necrotising stomatitis and of its sequel noma can stop progression of the disease; therefore detection and treatment of early intraoral necrotising lesions whether necrotising gingivitis, necrotising periodontitis or necrotising stomatitis are critical in preventing noma. We present an extreme case of noma in a malnourished HIV-seropositive child. There was an acute necrotic process affecting both the maxilla and the mandible with denudation of bone, spontaneous exfoliation of teeth, necrotising fasciitis and myonecrosis which destroyed the lips and cheeks and extended to the infra-orbital margins. There was severe disfigurement and severe impairment of function. Noma is primarily an anaerobic bacterial infection with secondary ischaemia leading to osteonecrosis and mid-facial destruction.
ISSN:1936-055X
1936-0568
DOI:10.1007/s12105-012-0393-0