Cancrum Oris

Restoration of an Upper Lip Affected by Necrotizing Ulcerative Stomatitis Using Bilateral Cheek Advancement with a Crescentic Perialar Excision

“…Early diagnosis and intervention with local debridement, better oral hygiene, systemic antibiotics, and nutritional support can help reduce the rates of mortality, fibrosis, and oral disfigurement. As NUS has been considered a reconstructive challenge because it affects complex functional and aesthetic units [3,4,7] and because it is often found only in developing countries, few studies have investigated NUS. Options for reconstruction range from local regional flap transfer to free tissue transfer.…”

Noma: neglected, forgotten and a human rights issue

“…Noma is a facial gangrene mainly occurring in malnourished children aged 1-5 years, living in extreme poverty. 1 Besides malnutrition other predisposing factors are measles, malaria, HIV and the presence of acute necrotizing gingivitis. 1,2 Noma is an opportunistic infection, associated with an imbalance of microorganisms.…”

First Experiences with Simultaneous Skeletal and Soft Tissue Reconstruction of Noma-Related Facial Defects

“…The facial gangrene (noma) leaves disfiguring lifetime facial defects. [1][2][3][4][5] As growing young infants after breast-feeding are most commonly affected, it can cause extensive soft tissue losses and major disturbances in the facial skeletal development. One unique aspect in noma surgery is extra-articular ankylosis, which has to be released for restoration of mandibular mobility and midface height.…”

“…While the rate of plastic surgically treated patients is still very low compared with the estimated prevalence of the disease, 9 the majority of these reconstructive procedures are still performed in suboptimal medical circumstances both by local professionals and humanitarian teams. 5,6,10,[11][12][13] In this context, any bony "restoration" of the facial skeleton was almost always limited to ankylosis resection. Autologous structural bone reconstruction was usually not performed, as this would imply more blood loss, operative time, surgical complexity, and postoperative swelling, which could impair patient safety under compromised circumstances.…”

“…All these patients were treated with the typical spectrum of local and regional soft tissue flaps according to the concepts of noma surgery well described in the pertinent literature. 5,10,12,[19][20][21][22][23] Over the years, we finally integrated microvascular options into our spectrum-even in suboptimal medical circumstances-with encouraging results for selected complex and huge defects. 7,16,18 The next logical step was the integration of viscerocranial bone reconstruction concepts for those cases.…”