One-stage reconstruction for defects caused by cancrum oris (noma).

Cancrum oris is a disease process that has been described for centuries, but now presents primarily in developing countries. The disease in known to occur in association with poor nutrition and exanthematous infections. The acute disease occurs usually in young children, and the infectious process causes destruction of the involved orofacial tissues with variable degrees of tissue loss and scar reaction in those who are affected and survive. The chronic sequelae of the acute disease process often require reconstructive surgery. We present the natural history of the disease process and its causes, and demonstrate the wide spectrum of resulting defects that challenge the reconstructive surgeon. Because of the socioeconomic situation inherent with these patients and the volume of patients in need of treatment with this disease, innovative and efficient treatment is required. We have demonstrated methods of reconstructive surgery that differ from the multiple staged procedures described in previous studies by allowing for one-stage surgical reconstruction of even the most complex cases. This allows for treatment of the majority of patients in their native countries in a cost-effective and safe manner, and treatment of more severely afflicted individuals in modern medical centers without their having to spend a long time period away from their homes.