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Cancrum oris: management, incidence, and implications of human immunodeficiency virus in Zambia
1Department of Surgery, School of Medicine, University Teaching Hospital, Lusaka, Zambia.
Insights
This study analyzed 81 pediatric cases of cancrum oris in Zambia, finding reconstructive surgery successful in 55 children. Management challenges and human immunodeficiency virus implications were also discussed.
Area of Science:
- Pediatric Plastic Surgery
- Oral and Maxillofacial Surgery
- Public Health in Zambia
Background:
- Cancrum oris (necrotizing stomatitis) is a severe oral gangrenous disease primarily affecting children.
- The University Teaching Hospital in Lusaka, Zambia, serves as a key referral center for pediatric cases.
- Previous research on cancrum oris in Zambia is limited, necessitating further investigation into its epidemiology and management.
Purpose of the Study:
- To report on the surgical management of pediatric cancrum oris cases over a 15-year period.
- To identify challenges in managing cancrum oris, including anesthetic difficulties, trismus, and flap selection.
- To explore potential contributing factors, such as dietary habits and the impact of human immunodeficiency virus (HIV).
Main Methods:
- Retrospective review of 81 pediatric patients diagnosed with cancrum oris admitted between 1979 and 1993.
- Analysis of patient demographics, geographical origin, and outcomes including mortality and surgical intervention.
- Discussion of clinical management issues and potential etiological associations.
Main Results:
- A total of 81 children (29 boys, 52 girls) were admitted; 58 were under 3 years old.
- Mortality was significant, with 11 deaths during initial medical treatment and 12 post-operative deaths.
- 55 patients underwent successful reconstructive surgery, with specific challenges in anesthesia, trismus, and flap choice noted.
Conclusions:
- Reconstructive surgery offers a viable treatment option for pediatric cancrum oris, despite significant early mortality.
- Dietary habits and geographical factors appear to influence disease prevalence in certain Zambian provinces.
- The study highlights the need for improved early diagnosis, management strategies, and consideration of HIV co-infection.
Abstract:
The University Teaching Hospital is situated in the Zambian capital, Lusaka. In a 15-year period (1979 to 1993), 81 child patients with cancrum oris were admitted to the pediatric plastic surgery unit. There were 29 boys and 52 girls, of whom 58 were below 3 years of age. The majority of them were from certain provinces where the population is comparatively much lower than in other provinces of Zambia. The dietary habits in cancrum orisprone provinces are quite different than those of other provinces of Zambia. Of 81 patients, 3 refused surgery, 11 died during early medical treatment, and 12 died following early minor surgery. A total of 55 patients had reconstructive surgery by one of the authors (Nath). Problems encountered during management, such as anesthesia, trismus, and choice of appropriate flaps, are discussed in this paper. The implication of human immunodeficiency virus is also addressed.