{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T04:44:25Z","timestamp":1774068265844,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,9,8]],"date-time":"2018-09-08T00:00:00Z","timestamp":1536364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Noma is a devastating and destructive disease of the face for which there is a dearth of information regarding surgical options. Herein, we describe the facial deformities and patient characteristics in a patient population affected by noma and the surgical approaches used in treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective case series of a Doctors Without Borders (M\u00e9decins Sans Fronti\u00e8res) intervention at Sokoto Children's Noma Hospital in northern Nigeria, the highest\u2010volume noma hospital in the world.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010two procedures were performed on 18 patients with noma, 44% of whom were children. The majority of patients (n\u2009=\u200910, 55.5%) were made aware of surgical care through a Doctors Without Borders outreach program. Patients' reasons for seeking care included functional (61.1%, n\u2009=\u200911), appearance (61.1%, n\u2009=\u200911), and social stigma (66.7%, n\u2009=\u200912). The majority (83.3%, n\u2009=\u200915) had lip involvement. Four patients (22.2%) underwent staged flap procedures including prelamination, flap delay, or pedicle division. The mean duration of surgical procedure was 87 minutes (range 5\u2013306 minutes). The minor complication rate was 16%. There were no major complications or deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Noma is a mutilating disease of the face that occurs in settings of extreme malnutrition. A total of 55.5% of noma patients were made aware of surgical care through outreach programs. The majority of noma patients seek care to improve function (61.1%) and appearance (61.1%), and to address social stigma (66.7%). A total of 83.3% of noma patients had lip involvement. Facial reconstructive surgeons must rely on principles of congenital, traumatic, and oncologic deformity repair while focusing on safe, reliable procedures for low\u2010resource settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 129:96\u201399, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27230","type":"journal-article","created":{"date-parts":[[2018,9,8]],"date-time":"2018-09-08T13:01:43Z","timestamp":1536411703000},"page":"96-99","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Noma surgery"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7786-7812","authenticated-orcid":false,"given":"David A.","family":"Shaye","sequence":"first","affiliation":[{"name":"Doctors Without Borders, Amsterdam Holland. Noma Project Sokoto Nigeria"},{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Massachusetts Eye and Ear, Boston Children's Hospital, Harvard Medical School Boston Massachusetts"},{"name":"Department of Global Health and Social Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts"},{"name":"Department of Otolaryngology University Teaching Hospital Kigali, University of Rwanda, College of Medicine &amp; Health Sciences Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Winters","sequence":"additional","affiliation":[{"name":"Doctors Without Borders, Amsterdam Holland. Noma Project Sokoto Nigeria"},{"name":"Department of Otorhinolaryngology Ochsner Health System New Orleans Louisiana U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Rabbels","sequence":"additional","affiliation":[{"name":"Doctors Without Borders, Amsterdam Holland. Noma Project Sokoto Nigeria"},{"name":"Department of Oral and Maxillofacial Surgery Katharinen Hospital Stuttgart Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adenyiyi Seminyu","family":"Adentunji","sequence":"additional","affiliation":[{"name":"Doctors Without Borders, Amsterdam Holland. Noma Project Sokoto Nigeria"},{"name":"Children's Noma Hospital Sokoto State Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aidan","family":"Magee","sequence":"additional","affiliation":[{"name":"Doctors Without Borders, Amsterdam Holland. Noma Project Sokoto Nigeria"},{"name":"Department of Anaesthesia and Critical Care Our Lady's Children's Hospital Crumlin Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Vo","sequence":"additional","affiliation":[{"name":"Doctors Without Borders, Amsterdam Holland. Noma Project Sokoto Nigeria"},{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,9,8]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"178","article-title":"Noma in Viet\u2010Nam","volume":"29","author":"Phan\u2010Dinh\u2010Tuan","year":"1962","journal-title":"Indian J Pediat"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000055445.84307.3C"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/path.1700160118"},{"key":"e_1_2_6_5_1","first-page":"17","article-title":"Noma: clinical and evolutive aspect","volume":"93","author":"Evrard L","year":"1996","journal-title":"Acta Stomatol Belg"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-0825.1999.tb00085.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(46)91406-7"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69004-1"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800531109"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1999.61.909"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000222218.88688.37"},{"key":"e_1_2_6_12_1","unstructured":"US State Department travel advisory website. Available at:https:\/\/travel.state.gov\/content\/passports\/en\/alertswarnings\/nigeria-travel-warning.html. Accessed September 9 2017."},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000076217.58995.E2"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)54062-8"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-196508000-00004"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002380050094"},{"key":"e_1_2_6_17_1","volume-title":"The Surgical Treatment of Noma","author":"Bos K","year":"2006"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.27230","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.27230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T04:36:11Z","timestamp":1694666171000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.27230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,8]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1002\/lary.27230"],"URL":"https:\/\/doi.org\/10.1002\/lary.27230","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,8]]},"assertion":[{"value":"2018-02-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-03-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}