School of Global Health & Bioethics, Euclid University, Banjul, Gambia.
EUCLID (Euclid University), Bangui, Central African Republic.
PLoS Negl Trop Dis. 2022 Sep 13;16(9):e0010372. doi: 10.1371/journal.pntd.0010372. eCollection 2022 Sep.
Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal.
A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,-the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score.
A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25-50%), Grade-3 (50-75%), Grade-1 (0-25%), and Grade-4 (75-100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma.
The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one's family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity.
坏疽性口面毁损症是一种影响面颌部组织的破坏性疾病，主要发生于营养不良的儿童。组织坏疽或坏死首先发生在口腔，最终在口腔内扩散，并伴有软硬组织破坏。如果不加以控制，病情自然发展会导致面部皮肤穿孔，形成严重的容貌和功能缺陷，常累及中面部结构。此外，该病发展迅速，如果不及时干预，可导致死亡。
本研究采用回顾性临床病例对照研究，评估了埃塞俄比亚坏疽性口面毁损症的后遗症和严重程度。对诊断为坏疽性口面毁损症的患者的病历进行了回顾。这些病历资料分别来自埃塞俄比亚三个主要的坏疽性口面毁损症治疗中心：耶卡蒂 12 医院、Facing Africa 和哈拉尔项目。根据 NOIPTUS 评分，评估了面部组织损伤的严重程度和张口度（牙关紧闭）的程度。
共回顾了 163 份病历。其中，52%（n=85）和 48%（n=78）的患者分别报告了左侧和右侧面部缺陷。面部缺陷的严重程度从轻度到重度组织损伤不等。具体来说，42.3%（n=69）、30.7%（n=50）、19%（n=31）和 8%（n=13）的患者报告的组织损伤程度分别为 2 级（25%50%）、3 级（50%75%）、1 级（0%25%）和 4 级（75%100%）。在我们的研究中，颊部、上唇、下唇、鼻子、硬腭、上颌、口腔口角、颧骨、眶下区、下颌和颏部等是常受疾病影响的主要面部解剖区域。上唇、下唇和鼻子完全缺失也被认为是坏疽性口面毁损症的后遗症。
坏疽性口面毁损症的死亡率报告在 85%至 90%之间。少数存活下来的患者会遭受毁容和功能障碍，影响言语、呼吸、咀嚼，甚至导致视力改变。通常，容貌损伤会成为耻辱的根源，导致他们与社会和家庭隔绝。同样，我们的研究也发现了很高水平的面部组织损伤和精神疾病发病率。
