[Noma. Proposal for a surgical treatment]

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Global Health

Background:

• Noma is a devastating necrotizing disease primarily affecting children in resource-limited settings.
• Surgical intervention is often necessary to address extensive tissue loss and functional impairments like trismus.
• Management in field settings presents unique challenges and requires adaptable strategies.

Purpose of the Study:

• To describe the surgical approach for noma treatment in a surgical camp setting.
• To outline a strategy addressing both tissue defects and trismus.
• To evaluate the efficacy of specific reconstructive techniques.

Main Methods:

• Utilized local and distant flaps for tissue reconstruction, guided by the NOILTULP classification.
• Employed fascia temporalis skin grafts for oral lining.
• Combined with submental or Backamjian flaps for external coverage.
• Addressed trismus through staged osteotomies in advanced cases.

Main Results:

• Fascia temporalis grafts combined with submental/Backamjian flaps provided effective oral lining and external coverage.
• Staged osteotomies were necessary for trismus management in later disease stages.
• Prevention strategies for initial stomatitis and trismus were highlighted.

Conclusions:

• A combined approach using skin grafts and distant flaps is effective for noma reconstruction.
• Early antibiotic treatment of stomatitis and preventative measures for trismus are vital.
• Surgical camps can successfully manage complex noma cases with appropriate planning.