Noma (Cancrum Oris): Case Report And Review Of The Pathogenesis

Methods:  Literature review of necrotizing oral diseases with critical comparison of our case report. We present an extreme case of Noma in a malnourished HIV-seropositive child.

Results:  Noma (Cancrum Oris) is a mutilating necrotizing disease of the oro-facial tissues. It affects predominantly debilitated malnourished children, in whom the necrotic process may cause severe damage to mid-facial structures. In our extreme case of Noma, there was an acute necrotic process affecting both the maxilla and the mandible with denudation of bone, spontaneous exfoliation of teeth, necrotizing fasciitis and myonecrosis which destroyed the lips, cheeks and extended to the infra-orbital margins. There was severe disfigurement and severe impairment of function with negative impact to the patient's quality of life. 

Conclusions:  Noma is primarily an anaerobic bacterial infection with secondary ischemia leading to osteonecrosis and midfacial destruction. Antibiotic treatment during any stage of Necrotizing Stomatitis and of its sequel Noma can stop progression of the disease. Our patient was successfully resuscitated but now faces an arduous and daunting programme of surgical treatment and functional rehabilitation. Can the best outcome be confidently predicted and be  successfully archieved in this extreme case?