Epidemiology
- First described by Tourdes in 1848
- Also called noma and gangrenous stomatitis
- Occurs almost exclusively in children
- 80% patients are less than 10 years old
- Virtually unknown in Europe and North America
- Still seen in developing countries
- Often associated with immunosuppression
Clinical features
- Aetiology unclear but it may be a sequelae of acute necrotising gingivitis
- Results in spontaneous necrosis of the mucous membrane of the oral cavity
- Spreads into adjacent structures including cheek, nose, palate
- Early clinical features include
- Excessive salivation
- Marked fetid odour
- Grey discolouration of the affected area
- Child often has features of chronic malnutrition
- Poor oral hygiene is invariably present
- Also occurs in association with:
- Measles
- Typhoid
- Bacillary dysentery
- Tuberculosis
- Whooping Cough
- Leukaemia
- Clinical course can be variable
Picture provided by Farham Shahzed, King Edward Medical College, Lahore, Pakistan
Investigation
- Borrelia vincenti and fusiform bacilli can be cultured in most cases
- Anaerobic bacteria may be present in rapidly progressing cases
- Facial x-rays and CT will determine degree of bone involvement
Management
- Requires a multidisciplinary team approach
- In the early stages child will need:
- Dehydration
- Enteral nutrition
- Antibiotics
- Wound debridement
- Late treatment includes:
- Facial reconstruction with myocutaneous and osteomyocutaneous flaps
- Temporomandibular joint arthroplasty
- Mortality rate is now less than 10%
Bibliography
Adolph H P, Yugueros P, Woods J E. Noma: a review. Ann Plast Surg 1996;
37: 657-668.
Oji C. Cancrum oris: its incidence and treatment in Enugu, Nigeria. Br J Oral Maxillofac
Surg 2002; 40: 406-409.
Valadas G, Leal M J. Cancrum oris (noma) in children. Eur J Paed Surg 1998;
8: 47-51. |