Cancrum oris: A devastating orofacial gangrene

Background: Noma or cancrum oris is an uncommon disease that results in loss of tissue in the oronasal region secondary to gangrenous slough. As most patients with noma do not report until the disease is at an advanced stage, its onset and progression remain a mystery. Survivors of this disease suffer severe facial deformity due to loss of facial tissues and scarring. Reconstruction of such type of defects was aimed to maintain oral competence, sufficient oral access, and preservation of sensation.Case: A woman, 47 years old, experience with a chief complaint of the deformed right upper lip for the past 45 years. The patient is known to have a history of deformity on the right upper lip region when the patient was two years old. The patient stated that it originally started with swelling on the right cheek accompanied by redness and painful sensation.Result: An extensive scar along with half of the upper lip missing was found in the physical examination, causing exposure of anterior maxillary teeth. A full-thickness defect of half of the upper lip with severe scar contracture was also found in the further examination, thereby constricting the oris. The patient was planned for surgical management under general anesthesia. Lip reconstruction using an Estlander flap was done.Conclusion: Reconstruction must be planned carefully to restore the natural contours of the lip. The Estlander flap is one of the treatment choices used for labial defects that include the commissure.

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Noma management in a 47-years-old female patient using estlander flap: a case report

Brahmananta

Wibawa

Asmarajaya³

2020

Intisari Sains Medis

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Single-stage reconstruction of traumatic lower lip defects with chin island myocutaneous and labial mucosal flap

Sahai

Singh

2022

National Journal of Maxillofacial Surgery

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In the present study of eight cases of traumatic lower lip defects, the reconstruction was achieved in a single stage by V-Y advancement island chin myocutaneous flap and labial mucosal advancement flap. There are many methods described for the reconstruction of small-to-large size of lower lip defects from straight-line closure of small defects to local flaps and free flaps for large defects. V-Y advanced chin flap has been reported previously also for the repair of lower lip defect with varying results. The vermilion reconstruction in others reported cases was done with the free mucosal grafts, V-Y labial mucosa advancement, or pedicled tongue flaps. Tongue flap is a two-stage procedure with esthetically unnatural look and an irregular surface of the vermilion. The free mucosa graft showed necrosis partial or complete resulting in irregular surface of vermilion and notching in the lip. V-Y labial mucosa advancement was done more for a small defect of the lip only. In the present series, we have repaired the vermilion of the lip by labial mucosal advancement flap, muscle by advancement of orbicularis oris from chin flap, and skin by V-Y advancement of island myocutaneous chin flap. Our results showed normal oral size with no evidence of microstoma or commissural distortion; oral competence was good with normal sphincteric function. The vermilion reconstructed had normal color and sensation. Lip seal was very good without notching defect in the vermilion. Drooling of saliva or speech defect was not noticed. The facial expressions and the look of the face were near normal. Hence, esthetically and functionally, the results were good without any irregularity or notching of the lip along with no incidence of drooling of saliva. We think that this technique may be considered as a procedure of choice for managing the moderate-to-large post traumatic defects of the lower lip. It is good esthetically and functionally besides being single stage for reconstructing moderate-to-large defects of the lower lip and is satisfying to the patient.

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A novel technique of reconstruction of vermilion by pedicled myomucosal labial vestibular flap in traumatic defect of lower lip

Singh

Sahai

Singh

2022

National Journal of Maxillofacial Surgery

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We present a new technique of reconstruction of a partial defect of vermilion in a case of post traumatic defect of lower lip. The vermilion defect was reconstructed by the myomucosal flap taken from the labial side of lip posterior and below the anterior lip defect. The lower rounded part of this 3 cm × 2 cm rectangular flap was brought on the outer anterior lip defect through a hole made by splitting the orbicularis oris muscle below the vermilion and its lower end was rotated upward to reconstruct the defect in the anterior and inferior part of vermilion. The secondary defect on the inner lip was closed by mobilization of mucosa. The triangular-shaped skin loss of anterior lower lip and its underlying muscle was closed in anatomic layers meticulously after mobilization of muscle and skin on both sides. The orocutaneous communication created was closed after 3 weeks by a minor operation under local anesthesia. The mouth opening remained normal between the period of lip repair and closure of iatrogenic orocutaneous communication. Good shape with normal color of vermilion and length having proper lip fullness was achieved without any microstomia. The surface of vermilion was smooth without any irregularity. The single scar of lower lip was supple and mobile over the underlying muscle. There was no deglutition, chewing, labial phonation, or any drooling saliva problems. The procedure provided functionally and esthetically satisfying result. We authors have not found a similar technique of lip reconstruction in the literature.

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Cancrum oris: A devastating orofacial gangrene

Cited by 3 publications

References 6 publications

Noma management in a 47-years-old female patient using estlander flap: a case report

Noma management in a 47-years-old female patient using estlander flap: a case report

Single-stage reconstruction of traumatic lower lip defects with chin island myocutaneous and labial mucosal flap

A novel technique of reconstruction of vermilion by pedicled myomucosal labial vestibular flap in traumatic defect of lower lip

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