Noma surgery

Abstract

OBJECTIVE: Noma is a devastating and destructive disease of the face for which there is a dearth of information regarding surgical options. Herein, we describe the facial deformities and patient characteristics in a patient population affected by noma and the surgical approaches used in treatment. METHODS: Retrospective case series of a Doctors Without Borders (Médecins Sans Frontières) intervention at Sokoto Children's Noma Hospital in northern Nigeria, the highest-volume noma hospital in the world. RESULTS: Twenty-two procedures were performed on 18 patients with noma, 44% of whom were children. The majority of patients (n = 10, 55.5%) were made aware of surgical care through a Doctors Without Borders outreach program. Patients' reasons for seeking care included functional (61.1%, n = 11), appearance (61.1%, n = 11), and social stigma (66.7%, n = 12). The majority (83.3%, n = 15) had lip involvement. Four patients (22.2%) underwent staged flap procedures including prelamination, flap delay, or pedicle division. The mean duration of surgical procedure was 87 minutes (range 5-306 minutes). The minor complication rate was 16%. There were no major complications or deaths. CONCLUSION: Noma is a mutilating disease of the face that occurs in settings of extreme malnutrition. A total of 55.5% of noma patients were made aware of surgical care through outreach programs. The majority of noma patients seek care to improve function (61.1%) and appearance (61.1%), and to address social stigma (66.7%). A total of 83.3% of noma patients had lip involvement. Facial reconstructive surgeons must rely on principles of congenital, traumatic, and oncologic deformity repair while focusing on safe, reliable procedures for low-resource settings. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:96-99, 2019.