Noma, whose name comes from the Greek “devour”, is a form of facial gangrene (tissue death, or necrosis) that mainly affects children suffering from malnutrition, poor general health and poor health. Oral hygiene. According to the World Health Organization (WHO), around 140,000 people worldwide have the disease each year.
Noma, also called cancrum oris, begins with a lesion in the mouth, which spreads and quickly destroys surrounding tissues such as the lining of the mouth, muscles and even the bones of the cheek, jaw, or even of the nose. The gangrenous tissues die and fall, causing severe mutilations of the face.
Without treatment, this terrible disease is almost always fatal.
Causes of noma
The exact cause of noma is unknown. Little research is conducted on the disease and yet it is unclear how it begins.
In most cases, people are not examined by a doctor or are very late when the lesions are already severe.
It is likely an infection caused by several microorganisms. Harmful spirochaete and fusobacterium bacteria are often found in lesions, but many other bacteria such as Staphylococcus aureus may also be involved.
At the same time, other factors contribute to the development of noma, in particular:
- malnutrition
- various infections (especially measles, malaria and HIV infection)
- lack of hygiene
Thus, the people affected live in conditions of extreme poverty and are in poor health (viral infection, malnutrition, dehydration, etc.).
Who is affected?
In the past, noma, sometimes called “the face of poverty,” was widespread around the world, including Europe and North America.
Today, noma cases occur exclusively in the poorest populations, particularly in West Africa and India. Cases are also reported in South America and Southeast Asia.
In addition, 90% of cases occur in children under 10. Undernourished children aged 2 to 5 are the most affected
Evolution and possible complications
Without treatment, the mortality rate of noma reaches 80 to 90%.
Survivors suffer from severe facial mutilations. A majority of them are unable to feed, talk and breathe normally.
The healing of the lesions often leads to a permanent constriction of the jaws (the muscles of the jaw are contracted permanently, making the opening very difficult).
Victims of noma are sometimes rejected by their community because the disease is often seen as a curse. Surviving children are therefore subject to anxiety, guilt and withdrawal, which add to the functional difficulties of nutrition and language.
The symptoms of noma
Initial stage
Noma begins with a small, apparently benign lesion inside the mouth.
It quickly turns into an ulcer (wound) and leads to edema (swelling) of the face.
The following symptoms appear:
- pain
- foul breath
- swollen neck ganglia
- fever
- Possible diarrhea.
In the absence of treatment, the lesion evolves after 2 or 3 weeks in a fulgurating way towards a gangrenous phase.
| Note: In rare cases, noma can affect the genitals. This form is called the noma pudendi . |
Gangrenous phase
The lesion extends around the mouth and can reach the lips, cheeks, jaws, nose and even the orbital area (around the eyes). The wound is very deep, since the muscles and bones are usually affected too.
The affected tissues become necrotic (they die forming a lesion called eschar). Necrotic tissue leaves a gaping wound when it falls: it is at this stage that the disease is highly deadly.
People at risk for noma
Noma mainly affects children under 10 living in conditions of extreme poverty. It strikes especially in poor rural areas, lacking drinking water and where malnutrition is common, especially in arid areas.
Risk factors
The factors favoring the development of noma most often incriminated are:
- Malnutrition and nutritional deficiencies, especially in vitamin C
- Bad dental hygiene
- Infectious diseases. Noma occurs most often in children who have contracted measles and / or malaria. HIV infection also increases the risk of noma, as do other conditions such as cancer, herpes or typhoid fever.
The prevention of a noma
| How to prevent noma? |
| Noma is strongly associated with poverty and occurs exclusively in remote, illiterate and malnourished communities. The lesions spread very quickly and the affected people often consult very late when they have the “chance” to be able to find a doctor.
The prevention of noma comes first and foremost by the fight against extreme poverty and by information on the disease. In areas where noma is prevalent, people are often unaware of this scourge. A study conducted by pediatricians in Burkina Faso in 2001 reveals that “91.5% of affected families were unaware of the disease”. As a result, patients and their families often delay seeking help. Here are some suggestions from the WHO for preventing this disease :
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Medical treatments of noma
Emergency treatment
The treatment of noma is based on rapid care that provides:
- Administering antibiotics to stop the progression of the lesions (penicillin G, metronidazole, aminoglycosides, etc.);
- to rehydrate the patient and provide him with adequate nutritional intake (most often by gastric tube);
- to clean the oral lesions daily with an antiseptic;
- To treat underlying diseases, such as malaria.
If administered quickly, this treatment can cure the patient in 80% of cases about . Many after-effects, both aesthetic and functional, are often deplored after healing.
Physiotherapy
Ideally, exercises should be performed daily during the healing of the lesions to prevent the tissues from retracting and impeding the opening of the jaw.
Surgery
When the patient is disfigured, surgical reconstruction may be considered one or two years later, once the tissue is well healed.
Surgery can restore mobility to the jaw, facilitate nutrition and language, including “repairing” the lesions creating a communication between the mouth and nose and limit the aesthetic prejudice and thus the psychosocial impact of scars.
Several international associations offer surgical reconstruction interventions to noma victims, but most of them are unfortunately not supported and remain stigmatized or even excluded in their community.
