Rakhorst Hinne A, Gresnigt Tom M, van Kooten Oscar, Nishikawa Hiroshi, Fourie Leroux, Mizen Kelvin D
Ziekenhuisgroep Twente/Medisch Spectrum Twente, Enschede, the Netherlands.
The Westbourne Centre, Birmingham, UK.
Plast Reconstr Surg Glob Open. 2023 Mar 6;11(3):e4844. doi: 10.1097/GOX.0000000000004844. eCollection 2023 Mar.
Noma is an infectious disease affecting mostly children aged 0-10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa's Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from the gums and progressively expanding into the cheek, nose, or eye regions. In an estimated 90% of cases, the disease is lethal as a result of systemic sepsis. For survivors, typical results are extensive defects of the cheek, nose, and periorbital and perioral regions. Due to the defects, extensive scarring is common, which leads to secondary problems such as growth alterations in an infant's skeleton due to inhibition and restraint of growth resulting typically in cicatricial skeletal hypoplasia. Other sequelae include trismus, partially caused by scarring or complete fusion between maxilla/zygomatic arch and mandible. The resulting overall disfiguring facial appearance results in patients being disabled and socially isolated.
Facing Africa is a UK-based non-governmental organization that treats the secondary problems of Ethiopian noma survivors. Operations are performed in Addis Ababa by a visiting expert team. Postoperatively, patients are seen annually for years after the surgery.
This article discusses basic principles, goals, and a practical surgical algorithm for operating on lip, cheek, and oral defects, based on 210 noma patients who were operated on in Ethiopia over a period of 11 years.
The suggested algorithm has proven to work for the Facing Africa team members and is considered shareware for all surgeons to use and benefit from.
坏疽性口炎是一种主要影响0至10岁儿童的传染病。尽管它在西方世界几乎已完全消失，但在许多发展中地区，主要是非洲的萨赫勒地区，仍然普遍存在。这种感染的表现类似于面部坏死性筋膜炎，起源于牙龈，并逐渐扩展到脸颊、鼻子或眼睛区域。据估计，在90%的病例中，由于全身性败血症，该疾病会导致死亡。对于幸存者来说，典型的后果是脸颊、鼻子以及眶周和口周区域出现大面积缺损。由于这些缺损，广泛的瘢痕形成很常见，这会导致继发性问题，例如婴儿骨骼生长改变，这是由于生长受到抑制和限制，通常会导致瘢痕性骨骼发育不全。其他后遗症包括牙关紧闭，部分原因是上颌骨/颧弓与下颌骨之间的瘢痕形成或完全融合。由此产生的面部整体毁容导致患者残疾并被社会孤立。
“面对非洲”是一个总部位于英国的非政府组织，致力于治疗埃塞俄比亚坏疽性口炎幸存者的继发性问题。由来访的专家团队在亚的斯亚贝巴进行手术。术后，患者在手术后的数年里每年接受检查。
本文基于11年间在埃塞俄比亚接受手术的210名坏疽性口炎患者，讨论了唇部、脸颊和口腔缺损手术的基本原则、目标和实用手术方案。
所建议的手术方案已被证明对“面对非洲”团队成员有效，并被视为可供所有外科医生使用并从中受益的共享软件。
