NOMA / CANCRUM ORIS

Noma is a form of infectious gangrene of the mouth. It is thought to be
caused by fusiform bacteria. It usually affects children 2 to 7 years of
age. Predisposed are malnourished children, especially those with
protein deficiency, hypovitaminosis and recurrent acute infections. The
disease generally starts as peridontitis, then ulcerative stomatitis,
always on one side of the mouth. It then progresses to gangrene with
extensive sloughing of adjacent tissue and necrosis of bone. The area is
foul-smelling and very painful. Untreated patients may die or survive with
a severe handicap.
Management of noma
- Start treatment as soon as the diagnosis is suspected!
- When only peridontitis is present, oral hygiene (e.g. chlorhexidine mouthwash) may
prevent development of noma.
- Massive doses of penicillin or in case of penicillin-allergy broad-spectrum
antibiotics for at least 2 weeks. Treat longer if necessary, until all signs of activity
have ceased.
- Intensive high-protein diet should be given, orally and parenterally, as well as
vitamin supplements.
- Early treatment may lead to great improvement of tissue defects.
Remaining deformities may need surgical repair.