Noma (cancrum oris): questions and answers

Noma (cancrum oris) is an infectious disease which destroys the ore-facial tissues and other neighboring structures in its fulminating course, It affe cts predominantly children aged 2-16 years in sub-Saharan Africa where the estimated frequency in some communities may vary from one to seven cases pe r 1000 children, The key risk factors are poverty, malnutrition, poor oral hygiene, deplorable environmental sanitation, close residential proximity t o livestock, and infectious diseases, particularly measles, Malnutrition ac ts synergistically with endemic infections in promoting an immunodeficient state, and noma results from the interaction of general and local factors w ith a weakened immune system as the common denominator. Acute necrotizing g ingivitis (ANG) is considered the antecedent lesion, Current studies sugges t that evolution of ANG to noma requires infection by a consortium of micro organisms with Fusobacterium necrophorum and Prevotella intermedia as the s uspected key players. Without appropriate treatment, mortality rate is 70-9 0%. Survivors suffer the twofold affliction of ore-facial disfigurement and functional impairment. Reconstructive surgery of the resulting deformity i s time-consuming and financially prohibitive for the victims who are poor.