Abstract
Objectives
We describe the experiences of the volunteer physicians treating Noma patients in two West African nations. Included is an extensive literature review describing preoperative methods, the pathogenesis of lesions, symptoms of the disease, and surgical repair techniques. Finally, we discuss consequences of the disease, specifically severe trismus secondary to temporomandibular joint ankylosis causing complications related to the delivery of anesthesia.
Methods
Description of 4 Noma patients treated in Liberia or Ghana at distinct stages. 1) Treatment of malnutrition and correction of electrolyte disturbances; 2) Treatment of underlying infections with antibiotics and debridement of lesions; 3) Surgical repair of necrotic areas and closure of the open wounds with appropriate anesthetic management; 4) Observation following surgical repair.
Results
We discuss in detail 4 illustrative patients who were encountered at varying stages of treatment. We describe extensive reconstruction under local anesthesia and other treatment options available to teams with resources such as micro-surgical techniques and the use of single-stage reconstruction. Fiberoptic intubation techniques were unavailable, and thus intubation was not attempted on patients with ankylosis.
Conclusions
Noma continues to grotesquely disfigure the poor malnourished children of Africa at an incidence of 4 per 1000, a 10-fold greater incidence than cleft lip. Untreated, Noma has a mortality rate up to 80%, with proper treatment that can be lowered to 10%. We demonstrate that remarkable results can still be accomplished without intubation with only local anesthesia. We acknowledge these limitations but illustrate the benefit is overwhelming to these patients.
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