Journal Article > ResearchFull Text
Laryngoscope. 2018 September 8; Volume 129 (Issue 1); DOI:10.1002/lary.27230
Shaye DA, Winters RD, Rabbels J, Adentunji AS, Magee A, et al.
Laryngoscope. 2018 September 8; Volume 129 (Issue 1); DOI:10.1002/lary.27230
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.
Journal Article > ReviewFull Text
Facial Plast Surg. 2021 January 31; Volume 37 (Issue 04); 439-445.; DOI:10.1055/s-0041-1722894
Miller LE, Shaye DA
Facial Plast Surg. 2021 January 31; Volume 37 (Issue 04); 439-445.; DOI:10.1055/s-0041-1722894
Necrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.
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.
Journal Article > ReviewAbstract Only
Curr Opin Otolaryngol Head Neck Surg. 2022 July 5; Volume 30 (Issue 4); 219-225.; DOI:10.1097/MOO.0000000000000819
Farley ES, Amirtharajah M, Shaye DA
Curr Opin Otolaryngol Head Neck Surg. 2022 July 5; Volume 30 (Issue 4); 219-225.; DOI:10.1097/MOO.0000000000000819
PURPOSE OF REVIEW
There is a need for concerted effort to increase global awareness about noma (cancrum oris). This paper aims to summarize the recent literature on noma and provide suggestions that could be implemented to raise awareness about this neglected disease.
RECENT FINDINGS
Noma has been recognized, diagnosed and reported for centuries. Despite significant progress in scientific methods over time, the published literature on noma has predominantly been of low level clinical and scientific evidence. Recent studies have reported on noma's global distribution and its predisposing risk factors, its treatment, its knowledge and beliefs and has included a number of literature reviews. Noma cases are being reported from an increasingly diverse set of geographical locations.
SUMMARY
Noma has largely been neglected in the research sphere. Noma is a preventable disease and its progression can be halted if patients are recognized and treated in the early stages of disease. Treatment for late stage noma survivors remains complex and time consuming, requiring substantial human and financial resources most commonly not achieving functional and cosmetic anatomy. The ultimate aim is therefore prevention, initiatives should be integrated into existing health programs.
There is a need for concerted effort to increase global awareness about noma (cancrum oris). This paper aims to summarize the recent literature on noma and provide suggestions that could be implemented to raise awareness about this neglected disease.
RECENT FINDINGS
Noma has been recognized, diagnosed and reported for centuries. Despite significant progress in scientific methods over time, the published literature on noma has predominantly been of low level clinical and scientific evidence. Recent studies have reported on noma's global distribution and its predisposing risk factors, its treatment, its knowledge and beliefs and has included a number of literature reviews. Noma cases are being reported from an increasingly diverse set of geographical locations.
SUMMARY
Noma has largely been neglected in the research sphere. Noma is a preventable disease and its progression can be halted if patients are recognized and treated in the early stages of disease. Treatment for late stage noma survivors remains complex and time consuming, requiring substantial human and financial resources most commonly not achieving functional and cosmetic anatomy. The ultimate aim is therefore prevention, initiatives should be integrated into existing health programs.