David A Shaye1,2,3,4, Ryan Winters1,5, Jens Rabbels1,6, Adenyiyi Seminyu Adentunji1,7, Aidan Magee1,8, Daniel Vo1,9. 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.
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 nomapatients were made aware of surgical care through outreach programs. The majority of nomapatients seek care to improve function (61.1%) and appearance (61.1%), and to address social stigma (66.7%). A total of 83.3% of nomapatients 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.
Authors: Shafi'u Isah; Mohana Amirtharajah; Elise Farley; Adeniyi Semiyu Adetunji; Joseph Samuel; Bukola Oluyide; Karla Bil; Muhammad Shoaib; Nura Abubakar; Annette de Jong; Monique Pereboom; Annick Lenglet; Mark Sherlock Journal: Trop Med Int Health Date: 2021-07-22 Impact factor: 3.918
Authors: Elise S Farley; Mohana Amirtharajah; Ryan D Winters; Abdurrazaq O Taiwo; Modupe J Oyemakinde; Adolphe Fotso; Linda A Torhee; Ushma C Mehta; Karla A Bil; Annick D Lenglet Journal: Trans R Soc Trop Med Hyg Date: 2020-11-06 Impact factor: 2.184