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Alternative namesCancrum oris; Gangrenous stomatitis
DefinitionNoma 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).
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.
Signs and testsPhysical 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.
TreatmentNoma 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.
Calling your health care providerMouth 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.
PreventionMeasures to improve nutrition, cleanliness, and sanitation may be helpful.
Update Date: 10/30/2003Philip L. Graham III, M.D., M.S., F.A.A.P., Department of Pediatrics, Children's Hospital of New York, Columbia University, New York, NY. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT