Clinico-pathological analysis of osteomyelitis in cancrum ois (Noma) patients seen in Noma children hospital, Northwest Nigeria

Background: Cancrum oris is a rapid and devastating infectious disease of the orofacial region, which can be life threatening in its fulminant stage. Infection of bone (osteomyelitis) is a possible sequelae of Noma (cancrum oris) and is more likely due to late presentation especially in our environment. A literature search revealed scanty research describing osteomyelitis in Noma patients. Objective: To analyze the clinico­pathology of osteomyelitis in Noma patients diagnosed and treated at Noma Children Hospital, Sokoto.Methods: The design was a 2-year retrospective study of records of Thirty­two patients who had sequestrectomy secondary to osteomyelitis in Noma (Cancrum oris). Age, gender, jaws affected and side of involvement were analyzed Results: The age ranged from 2­11 years with mean ±standard deviation 5.47 ± 2.68 years was recorded. Osteomyelitis in Noma patients was found among 17 (53.10%) males compared to 15 (46.90%) females. In 20 (62. 50%) of the cases, anterior maxillary involvement was observed and the remaining 12 (37. 50%) was found at the mandibular posterior region and it is more common on the left side. Result of histopathology showed both acute and chronic inflammatory cells. Necrosis and bone hyperactivity was observed in most of the slides. Conclusion: Osteomyelitis is a common complication of Noma and its treatment is of paramount importance for adequate management of Noma patients.

Cariogenicity of Vitamin Supplements for Children / 대한소아치과학회지

The purpose of this study is to analyze the cariogenicity of vitamin supplements for children by the Caries Potentiality Index (CPI), pH drop capacity, proliferation rate of Streptococcus mutans.Four vitamin supplements were selected - Noma (NM), Cenovis Kids (CK), Animal Parade (AP), and Character Vitamin (CV).CPI value decreased in the order of AP, CV, CK, and NM. Initial values of all experimental groups showed acidity below pH 7.0. Analysis of the colony forming units of Streptococcus mutans showed that NM and CV resulted a higher proliferation rate (p < 0.05) than CK and AP (p < 0.05). Bacterial activity of the control group was lower than other groups when observed with a confocal laser scanning microscope.Considering the bacterial activity and acidity of vitamin supplements, it is necessary to pay close attention when children taken the vitamin supplements for their oral health.

Staged lower lip reconstruction following gangrenous stomatitis in an immunosuppressed patient

A 70-year-old male with a history of diabetes mellitus, hypertension, and coronary stent insertion visited our hospital 7 days after biting his lower lip. Swelling and inflammation had worsened despite debridement and antibiotic treatment. On the 8th hospital day, fungal infection with Candida albicans and superimposed bacterial infection with Klebsiella pneumoniae were found on tissue culture. Extensive necrosis resulted in a defect of approximately 3/4 of the entire lower lip and a full-layer skin defect from the vermilion to the gingivobuccal sulcus at the right corner of the mouth. To correct drooling, incomplete lip sealing, and trismus, staged reconstruction was performed with consideration of cosmetic and functional features. The treatment process using staged reconstruction and antifungal treatment for an extensive lower lip defect caused by fungal stomatitis is described.

Restoration of an Upper Lip Affected by Necrotizing Ulcerative Stomatitis Using Bilateral Cheek Advancement with a Crescentic Perialar Excision

Necrotizing ulcerative stomatitis (NUS) refers to ulceration of the oral mucosa that precedes rapid orofacial soft- and hard-tissue destruction. NUS on the upper lip is considered a reconstructive challenge because of the functional importance and complex multidimensional structure of the facial units that are involved, and is most commonly found in developing countries. Therefore, few studies have been conducted on NUS. Moreover, reconstruction options vary from local regional flaps to free-tissue transfers. We report a very interesting case in which we performed regional flap surgery using bilateral cheek advancement in a patient with NUS. A 75-year-old woman with a history of diabetes mellitus and hypertension, but no other immunological diseases, presented with skin necrosis on the upper lip. At presentation, necrotic tissue covered the upper lip and philtrum, but it had not invaded the nose or lower lip. After debridement of the necrotic tissue, approximately 70% of the upper lip was missing. We therefore designed a bilateral cheek advancement and rotation flap, in which the flap was sutured in 3 layers. There was no need to perform additional procedures, as the flap healed well and showed no other complications or recurrence. The patient exhibited good voluntary muscle control and oral competence while eating and drinking, and she was also very satisfied with the cosmetic results. Thus, regional flap surgery using a simple advancement flap may result in good recovery of both functional and aesthetic units in patients with NUS.

Are the Cardiac Biomarkers in the Emergency Room Sufficient to Predict Adverse Events in Acute Pulmonary Embolism?

PURPOSE: The aim of this study is to determine whether cardiac biomarkers, such as N-terminal-proB-type natriuretic peptide (NT-proBNP), are good predictors of adverse events in acute pulmonary embolism (APE). METHODS: We conducted a retrospective analysis of patients with APE, which was confirmed by a computed tomography in the emergency room. Patients were divided into 2 groups: the major adverse event (MAE) group and the no-MAE group. MAE was defined as one of the following occurrences: in-hospital-death, cardiopulmonary resuscitation, mechanical ventilation, vasopressors, thrombolysis, or surgical embolectomy. Blood samples were obtained during the first hour of presentation to the emergency room. RESULTS: A total of 90 patients were included in this study. Twenty-seven patients had MAE. According to the univariate analysis, NT-proBNP, troponin I, and D-dimer plasma levels were significantly higher in the MAE group than in the noMAE group (919.8 vs. 2,131.0 ng/mL, p=0.032; 0.091 vs. 0.172 ng/mL, p=0.037; 2.43 vs. 3.74 ng/mL, p=0.049, respectively). However, according to the multivariate logistic regression, NT-proBNP was not independently associated with MAE in APE (odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Conversely, troponin I was independently associated with MAE (odds ratio, 1.09; 95% confidence interval, 0.99-1.18). The NT-proBNP plasma level was not significantly different between the right ventricular dysfunction (RVD) group and the no-RVD group (p=0.178). CONCLUSION: The NT-proBNP level, unlike the troponin I level, in the emergency room was not identified as an independent predictor of MAE in acute pulmonary embolism. Further studies of large-scale with controlled timing of blood sampling and echocardiography are required.

Bony fusion of the maxilla and mandible as a sequelae of noma: A rare case report

Noma is a gangrenous disease of the orofacial region that leads to severe facial tissue destruction and is a significant cause of death among children. With the advent of modern antibiotics and improved nutrition, children with noma may survive into adulthood, but must face the challenge of undergoing repair of the sequelae of noma. This report describes a case of bony fusion of the maxilla and mandible in a 28-year-old female patient, which was a sequelae of a childhood case of noma.

Occurrence of yeasts, pseudomonads and enteric bacteria in the oral cavity of patients undergoing head and neck radiotherapy

The aim of this study was to evaluate the occurrence of yeasts, pseudomonads and enteric bacteria in the oral cavity of patients undergoing radiotherapy (RT) for treatment of head and neck cancer. Fifty patients receiving RT were examined before, during and 30 days after RT. Saliva, mucosa, and biofilm samples were collected and microorganisms were detected by culture and polymerase chain reaction (PCR). The most prevalent yeasts in patients submitted to RT were Candida albicans, C. tropicalis, C. krusei, C. glabrata and C. parapsilosis. Citrobacter, Enterobacter, Enterococcus, Klebsiella, Proteus, and Pseudomonas were the most frequently cultivated bacteria. Before RT, targeted bacteria were cultivated from 22.2 percent of edentulous patients and 16.6 percent of dentate patients; 30 days after RT, these microorganisms were recovered from 77.8 percent edentulous and 46.8 percent dentate patients. By PCR, these microorganisms were detected from all edentulous patients, 78.1 percent of dentate patients. The presence of Gram-negative enteric roads and fungi was particularly frequent in patients presenting mucositis level III or IV. Modifications in the oral environment due to RT treatment seem to facilitate the colonization of oral cavity by members of family Enterobacteriaceae, genera Enterococcus and Candida.

Maxillofacial deformity caused by cancrum oris: a case report / 华西口腔医学杂志

Cancrum oris is a kind of gangrenous disease happening on the maxillofacial region. It is characterized by developing rapidly, high lethality and deforming rate. This article reported a case of maxillofacial deformity caused by cancrum oris, and discussed based on relevant literatures.

Le noma chez les enfants infectes par le VIH au CHU de Conakry: 5 cas

Les objectifs de cette etude etaient de decrire les aspects cliniques et therapeutiques chez 5 enfants atteints d'un noma revelateur d'une immunodepression par infection au VIH. Les malades ages entre 4 et 6 ans; ont ete recrutes entre fevrier 1999 et mai 2004. Le noma etait dans tous les cas localise au niveau de la region commisuro-jugale ou jugale. Les manifestations bucco-cervicales du VIH rencontrees etaient: la candidose et les adenopathies cervicales. Un traitement medical a base d'antibiotique (Ampiclline - 100mg/kg/jour en 3 prise par voie IV; Metronidazole 40 mg/kg/jour en 3 injections en intraveineuse par jour) combine a une chirurgie conservatrice a permis de limiter la destruction massive des tissus de la face et d'obtenir une cicatrisation des plaies par seconde intention. Tous les patients sont decedes d'infection opportuniste en l'absence de possibilite de traitement anti-retroviral et compte tenu du stade evolue du SIDA

Cancrum oris

Cancrum oris [noma] is an orofacial gangrene, which causes progressive and mutilating destruction of the infected tissues. The disease mainly occurs in children having malnutrition, poor oral hygiene and debilitating illness. It is well-documented in literature. In the international statistical classification of WHO, it is mentioned as necrotizing ulcerative stomatitis of children. Noma has disappeared from industrialized countries since the 20[th] century, but still common in third world countries especially in Africa

Cancrum Oculi in HIV Positive Child : a Case Report

Background: Cancrum oculi; is a very rare type of noma. Very few cases have been reported worldwide.Aim: To report a case of cancrum oculi in a six- month-old HIV positive negroid female. Setting:University of Port Harcourt Teaching Hospital (UPTH); Port Harcourt; Nigeria. Case Report: A six-month-old HIV seropositive negroid female child was seen in UPTH with necrotizing chronic ulcer at the angle of the left eye. There was also an intense oral thrush initially managed by the paediatricians and later referred to the Ophthalmology department for management. Clinical examinations and various investigations suggested the diagnosis of cancrum oculi.Conclusion: Cancrum oculi; like other variants of noma complicate immuno-deficiency or can be a primary disease in immuno-competent patients with poor hygiene. It is a preventable disease

Noma neonatorum.

Noma Neonatorum is characterized by a gangrenous process involving mucocutaneous junctions of oral, nasal and anal area and occasionally, the eyelids and scrotum. It is seen during the first few weeks of neonatal life in premature and low birth weight babies. Noma Neonatorum is commonly described with pseudomonas aeruginosa septicemia. A case of Noma Neonatorum associated with E.coli sepsis is described for the first time.

Le noma de l'enfant en milieu hospitalier de Bobo-Dioulasso (Burkina-Faso): aspects épidemiologiques et diagnostiques

Introduction: Le noma est une affection peuconnue au Burkina Faso. Cette étude décrit les aspectsépidémiologiques et diagnostiques de 59 cas de nomaà Bobo-Dioulasso (Burkina Faso).Méthodologie C'est une étude rétrospective sur10 ans incluant tous les enfants de moins de 15 ans,hospitalisés pour noma.Résultats : L' incidence du noma est de sept cas/an. La tranche de 1-5 ans a été la plus touchée. Dans46 cas (78%), le noma est survenu sur un terrain demalnutrition, associé à une mauvaise hygiène bucco-dentaire dans 45 cas (76,3%). Le tableau clinique estcelui d'un noma évolutif dans 51 cas (51/59) et d'unnoma séquellaire dans huit cas (8/59).Discussion-conclusion : Notre incidence de 7 cas/an est plus élevée que dans certaines études. D'autrestravaux trouvent comme nous que la tranche de 1-5ans a été la plus touchée. Le noma survient sur unterrain malnutri (78%) et d'hygiène orale défec-tueuse. Il devrait être mieux connu pour un traite-ment préventif adapté

Reconstruction of the Acquired Facial Deformity due to Cancrum Oris Sequelae

Acquired facial deformities following cancrum oris sequelae manifested variably according to the nature of tissue necrosis. In cases that tissue loss extends over a wide area of the face, or the tissue nature is different due to congenital facial cleft, it is difficult to reconstruct with a single operation. As cancrum oris has virtually disappeared from our country, clinical report of reconstruction is also rare. We report 5 cases of facial deformities following cancrum oris sequelae. Since 1988, five adult patients(4 female and 1 male) were treated by authors. These patients, with an age ranged from 47 to 58 years, all suffered from acquired facial cleft such as facial mutilation, asymmetry. The stages of operation were from 1 to maximum of 5 operations. All surgeries achieved satisfactory results after a long-term follow-up. But one surgery in the case of palatal mucosal flap for the coverage of reconstructed maxilla alveolar bone resulted tissue sloughness, followed by osteomyelitis. Those were debrided and discarded. In conclusion, all sites of deformities were positioned around one of the oral commissures. In their past medical history, they have been suffering from measles, typhoid fever and unknown febrile illness. We diagnosed the acquired facial deformity following cancrum oris sequelae. The reconstruction of acquired facial deformity following cancrum oris sequelae were difficult due to extensive multiple tissue defects. Therefore multiple staged operations were inevitable. The authors reconstructed 5 cases of simple and complex form of facial deformity with minimum staged\ operations. All patients were satisfied functionally and cosmetically.

Pseudomonas sepsis with Noma: an association?

We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of Pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases.

Oro-nasal fistula of infective origin and alveolar necrosis in a 13 year old boy.

An unusual case of oronasal fistulla of infective origin in a patient with a previous history of aplastic anemia and cancrum oris is discussed here in this report. As the general condition of the patient was not favouring the surgical closure, an obturator was fabricated and inserted to relieve the problems of regurgitation of food and fluids into the nasal cavity.