Noma

Alternative names
Cancrum oris; Gangrenous stomatitis

Definition
Noma is a disorder that destroys mucous membranes of the mouth (and later, other tissues) that occurs in malnourished children in areas of poor cleanliness.

Causes, incidence, and risk factors

Noma is a disorder that causes sudden, rapidly progressive tissue destruction. The mucous membranes (e.g., gums, lining of the cheeks) become inflamed and develop ulcers. The infection spreads from the mucous membranes to the skin. The tissues in the lips and cheeks die. Rapid, painless tissue breakdown continues and this gangrenous process can destroy the soft tissue and bone. Noma can also affect the mucous membranes of the genitals, spreading to the genital skin (this is sometimes called noma pudendi).

This disorder occurs primarily in young, severely malnourished children 2-5 years of age. Often they have had a preceding illness such as measles, scarlet fever, tuberculosis, malignancy, or immunodeficiency. It is seen in areas of poor cleanliness and sanitation. The exact cause is unknown, but may be bacterial (fusospirochetal organisms).

Risk factors include Kwashiorkor and other forms of severe protein malnutrition, poor sanitation and poor cleanliness, disorders such as measles or leukemia, and living in an underdeveloped country.

Symptoms

     
  • inflammation of the gums and inner cheeks (redness, tenderness, swelling)  
  • the inflamed area ulcerates if not treated (mouth ulcers, skin ulcers)  
  • the ulcers develop a foul-smelling drainage, causing breath odor and an odor to the skin  
  • the tissues begin to die (necrotic)  
  • eventual destruction of the bones around the mouth cause deformity and loss of teeth

Signs and tests
Physical examination shows inflamed areas of the mucous membranes, mouth ulcers, and skin ulcers. These ulcers have a foul-smelling drainage. There may be other signs of malnutrition.

Treatment
Noma can be fatal if left untreated or heal over time even without treatment. However, it can cause massive tissue destruction before healing. Treatment with antibiotics and nutritional support halts progression of the disease. Plastic surgery may be necessary to debride destroyed tissues and reconstruct facial bones. This will improve facial appearance, mouth, and jaw function.

Expectations (prognosis)
The skin lesions eventually heal even without treatment, but severe scarring and deformity can develop.

Complications

     
  • disfigurement  
  • discomfort

Calling your health care provider
Mouth sores and inflammation occur and persist or worsen (or other signs of noma develop). Children who live in underdeveloped countries or areas of less than optimal sanitation, and those who are malnourished, are at greater risk for this disorder.

Prevention
Measures to improve nutrition, cleanliness, and sanitation may be helpful.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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