cancrum oris

Last edited 03/2022 and last reviewed 04/2022

Noma (cancrum oris)

  • is a severely debilitating orofacial disease
    • is a gangrenous infection that causes rapid, widespread orofacial destruction
  • most frequently affects children between 2 and 5 years of age who live in low-income settings in Africa and Asia (2)
    • the World Health Organization (WHO) estimates that 140,000 new cases of noma occur annually (2)
      • affects malnourished children and mainly observed in tropical countries, particularly sub-Saharan Africa (3)
      • was once frequently reported in Europe and North America, although as living conditions improved in these settings, noma has been eradicated (besides a few sporadic cases in immunocompromised individuals)
        • leukaemic patients:
          • often a terminal complicaton of the disease
          • associated with the use of anti-inflammatory and immunosuppressive drugs
    • a mortality rate of approximately 85% and a burden of disease calculated to be a loss of 1-10 million disability-adjusted life year (3)
  • cause of noma is unknown, and noma is not contagious (1)
    • main risk factors for noma include chronic malnutrition, a lack of access to healthcare (specifically immunizations), and comorbidities such as measles and human immunodeficiency virus (HIV)
      • measles:
        • especially in the malnourished, typically in children in tropical Africa
        • cranium oris develops from an acute, ulcerative gingivitis
  • pathogenesis is a fast-spreading, noncontagious gangrenous infection occurring in the face, often preceded by acute necrotizing gingivitis, and stomatitis (3)
    • rare microbiological studies suggest an opportunistic infection caused by an imbalance in normal intraoral microorganisms
  • WHO classifies noma into stages: Stage 0: simple gingivitis, Stage 1: acute necrotizing gingivitis, Stage 2: oedema, Stage 3: gangrene, Stage 4: scarring, and Stage 5: sequelae
  • reported mortality rate for untreated patients is 90% within weeks after the onset of first symptoms (1)
    • treatment in the early acute stages with antibiotics, wound debridement, and nutritional support greatly reduces mortality and morbidity
    • late treatment consists of surgical rehabilitation, which is often complex (3)
  • survivors of the acute stages of noma face a lifetime of functional challenges such as difficulty eating and speaking