{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T03:40:16Z","timestamp":1781840416698,"version":"3.54.5"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010372","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000}}],"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T00:00:00Z","timestamp":1663027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,\u2014the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25\u201350%), Grade-3 (50\u201375%), Grade-1 (0\u201325%), and Grade-4 (75\u2013100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and\/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one\u2019s family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010372","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T17:41:08Z","timestamp":1663090868000},"page":"e0010372","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["A retrospective clinical, multi-center cross-sectional study to assess the severity and sequela of Noma\/Cancrum oris in Ethiopia"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1036-8530","authenticated-orcid":true,"given":"Heron Gezahegn","family":"Gebretsadik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent Cleenewerck","family":"de Kiev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,13]]},"reference":[{"issue":"3","key":"pntd.0010372.ref001","doi-asserted-by":"crossref","first-page":"e1556","DOI":"10.1371\/journal.pntd.0001556","article-title":"Bacterial diversity in oral samples of children in Niger with acute noma, acute necrotizing gingivitis, and healthy controls","volume":"6","author":"I Bolivar","year":"2012","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0010372.ref002","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s13256-017-1276-5","article-title":"Noma as a complication of false teeth (Ebiino) extraction: a case report","volume":"11","author":"M. 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Kimura","year":"2008","journal-title":"J Med Primatol"},{"issue":"8","key":"pntd.0010372.ref006","doi-asserted-by":"crossref","first-page":"e0006631","DOI":"10.1371\/journal.pntd.0006631","article-title":"Risk factors for diagnosed noma in northwest Nigeria: A case-control study, 2017","volume":"12","author":"E Farley","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0010372.ref007","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s15010-017-1034-z","article-title":"Noma in an HIV infected patient in Guinea-Bissau: a case report","volume":"45","author":"T Madsen","year":"2017","journal-title":"Infection"},{"issue":"8","key":"pntd.0010372.ref008","doi-asserted-by":"crossref","first-page":"e0008435","DOI":"10.1371\/journal.pntd.0008435","article-title":"Why is noma a neglected-neglected tropical disease?","volume":"14","author":"ML Srour","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0010372.ref009","article-title":"Risk Factors and Mortality Rate of Acute Cancrum Oris (noma) in Sokoto North-West Nigeria","author":"RO Braimah","year":"2017","journal-title":"A 13-year Survey"},{"issue":"9530","key":"pntd.0010372.ref010","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S0140-6736(06)69004-1","article-title":"Noma (cancrum oris)","volume":"368","author":"CO Enwonwu","year":"2006","journal-title":"The Lancet"},{"issue":"10","key":"pntd.0010372.ref011","article-title":"Noma: Life Cycle of a Devastating Sore\u2013Case Report and Literature Review","volume":"71","author":"A Auluck","year":"2005","journal-title":"J Can Dent Assoc"},{"key":"pntd.0010372.ref012","first-page":"00011","article-title":"The Real Face of \" Face of Poverty \": An Insight on Noma","volume":"1","author":"A Jain","year":"2017","journal-title":"Hosp Palliat Med Int J"},{"issue":"2","key":"pntd.0010372.ref013","doi-asserted-by":"crossref","first-page":"223","DOI":"10.4269\/ajtmh.1999.60.223","article-title":"Pathogenesis of cancrum oris (noma): confounding interactions of malnutrition with infection","volume":"60","author":"CO Enwonwu","year":"1999","journal-title":"Am J Trop Med Hyg"},{"issue":"10","key":"pntd.0010372.ref014","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1177\/1359105315624751","article-title":"People living with facial disfigurement after having had noma disease: A systematic review of the literature","volume":"22","author":"IM Wali","year":"2017","journal-title":"J Health Psychol"},{"key":"pntd.0010372.ref015","unstructured":"Kman NE, Kumar VP. 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[cited 2022 Mar 24]. 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A complication of chemotherapy induced neutropenia","volume":"47","author":"DC Brady-West","year":"1998","journal-title":"West Indian Med J"},{"issue":"1","key":"pntd.0010372.ref036","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1213\/ANE.0b013e3182908e6f","article-title":"Airway management in reconstructive surgery for noma (cancrum oris)","volume":"117","author":"MH Coupe","year":"2013","journal-title":"Anesth Analg"},{"issue":"6","key":"pntd.0010372.ref037","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/S0007-1226(03)00224-8","article-title":"Cancrum oris and noma: some etymological and historical remarks","volume":"56","author":"KW Marck","year":"2003","journal-title":"Br J Plast Surg"},{"issue":"3","key":"pntd.0010372.ref038","doi-asserted-by":"crossref","first-page":"193","DOI":"10.5624\/isd.2015.45.3.193","article-title":"Bony fusion of the maxilla and mandible as a sequelae of noma: A rare case report","volume":"45","author":"SB Bagewadi","year":"2015","journal-title":"Imaging Sci Dent"},{"issue":"2","key":"pntd.0010372.ref039","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1097\/SCS.0000000000006082","article-title":"Distraction Therapy to Correct Trismus Following Noma","volume":"31","author":"J Holle","year":"2020","journal-title":"J Craniofac Surg"},{"issue":"2","key":"pntd.0010372.ref040","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/00006534-199808000-00008","article-title":"Cancrum oris: management, incidence, and implications of human immunodeficiency virus in Zambia","volume":"102","author":"S Nath","year":"1998","journal-title":"Plast Reconstr Surg"},{"issue":"9","key":"pntd.0010372.ref041","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.ijom.2010.05.002","article-title":"Long-term results of trismus release in noma patients","volume":"39","author":"P Bisseling","year":"2010","journal-title":"Int J Oral Maxillofac Surg"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0010372","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010372","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T18:37:32Z","timestamp":1663958252000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010372"}},"subtitle":[],"editor":[{"given":"Joseph M.","family":"Vinetz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,9,13]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0010372","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0010372","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,13]]}}}