Medicines Sans Frontières-Netherlands, Amsterdam, The Netherlands.
Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria.
Facial Plast Surg Aesthet Med. 2024 Jul-Aug;26(4):488-496. doi: 10.1089/fpsam.2023.0079. Epub 2024 Mar 19.
Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations. To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria. Objective outcomes were recorded using the noma-specific NOITULP (nose, outer cheek, inner cheek, trismus, upper/lower lip, particularities) classification system. PROs were recorded using a locally developed tool. Postsurgical changes were assessed by Wilcoxon signed-rank testing. Linear regression was used to look for associated risk factors. The inter-rater reliability (IRR) of the NOITULP score was assessed using the weighted kappa statistic. Forty-nine patients (median age 25 years, 71% male) underwent local/regional flap reconstruction and/or trismus release. Twelve complications were reported. Univariate analysis showed a 3.20 change in PRO score (95% confidence interval 0.59 to 5.81, = 0.018) per kilogram the patient underwent at time of surgery. The NOITULP score improved from a presurgery median of 3.5 to 2.3 ( < 0.0001), however, the IRR was poor (kappa = 0.0894, < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 ( < 0.0001). Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria. Clinical Trial Registration: OCA017-63.
坏疽性口炎是一种面部的坏疽性感染，主要发生在营养不良和贫困人群中，会导致严重的面部畸形。本研究旨在评估尼日利亚西北部因坏疽性口炎接受重建手术患者的临床医生和患者报告的结局（PRO）在术前和术后的变化。使用特定于坏疽性口炎的 NOITULP（鼻子、外脸颊、内脸颊、牙关紧闭、上/下唇、特殊性）分类系统记录客观结局。使用当地开发的工具记录 PRO。通过 Wilcoxon 符号秩检验评估术后变化。使用线性回归寻找相关的危险因素。NOITULP 评分的组内相关系数（IRR）使用加权 Kappa 统计量进行评估。49 例患者（中位年龄 25 岁，71%为男性）接受了局部/区域性皮瓣重建和/或牙关紧闭松解术。报告了 12 种并发症。单因素分析显示，患者手术时的体重每增加 1 公斤，PRO 评分变化 3.20（95%置信区间 0.59 至 5.81， = 0.018）。NOITULP 评分从术前中位数 3.5 改善至 2.3（ < 0.0001），但 IRR 较差（kappa = 0.0894， < 0.0001）。PRO 评分也从中位数 7.0 改善至 12.0（ < 0.0001）。在尼日利亚西北部，面部重建手术可改善坏疽性口炎患者的 NOITULP 评分和 PRO。临床试验注册号：OCA017-63。
