Journal Article > ResearchFull Text
Facial Plast Surg Aesthet Med, Facial plastic surgery and aesthetic medicine, JAMA Facial Plastic Surgery. 2024 March 19; Online ahead of print; DOI:10.1089/fpsam.2023.0079
Amirtharajah M, Olaleye M, Oluyide B, Lenglet A, Ariti C, et al.
Facial Plast Surg Aesthet Med, Facial plastic surgery and aesthetic medicine, JAMA Facial Plastic Surgery. 2024 March 19; Online ahead of print; DOI:10.1089/fpsam.2023.0079
BACKGROUND
Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations.
OBJECTIVE
To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria.
METHODS
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.
RESULTS
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, p = 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 (p < 0.0001), however, the IRR was poor (kappa = 0.0894, p < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 (p < 0.0001).
CONCLUSIONS
Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria.
Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations.
OBJECTIVE
To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria.
METHODS
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.
RESULTS
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, p = 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 (p < 0.0001), however, the IRR was poor (kappa = 0.0894, p < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 (p < 0.0001).
CONCLUSIONS
Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria.