Clinical Paper
Reconstructive Surgery
Long-term results of trismus release in noma patients

https://doi.org/10.1016/j.ijom.2010.05.002Get rights and content

Abstract

Noma, also known as cancrum oris, is an infectious disease that results in a loss of orofacial tissue, due to gangrene of soft and bony tissue. It is especially seen in young children in the sub-Saharan region. Among the sequelae of patients who survive noma, trismus is one of the most disabling. This retrospective research studied the long-term results of trismus release in noma patients. Thirty-six patients could be traced in the villages and were included in the study. The mean mouth opening in this group was 10.3 mm (95% CI: 7.0; 13.6 mm) and the mean period after discharge from hospital was 43 months. Better mouth opening was observed in patients who continued physiotherapy after discharge, were older, and those with a ‘soft’ (vs. ‘hard’) inner and outer cheek on palpation. The result of trismus release in noma patients in the long term was extremely poor in this study.

Section snippets

Materials and methods

To recruit patients, the NCHS database was searched. Files with the terms ‘noma’ and ‘trismus’ were identified and the following data collected: address; gender; age; age of onset; date of admission; stage of noma; team number; information on the operations; pre- and postoperative mouth opening; postoperative physiotherapy; and date of discharge. The NOITULP classification, introduced by Marck in 1998, was used to determine the extent of defects in the noma patients10. In this classification, ‘T

Results

Two hundred and six files in the NCHS database contained the terms ‘noma’ and ‘trismus’, but only 130 files were present in the hospital and could be reviewed. Of these, 63 patients fulfilled the selection criteria and were visited in the field. In a journey of 1900 miles to 45 villages, 36 patients were found and included in the study. The remaining nine patients had given incorrect addresses, were not present at the time of the visit or were not traceable. The 18 people who were not visited

Discussion

Since 1996, teams of specialists have travelled to NCHS in Sokoto, Nigeria, to operate on patients who have survived noma. One of their objectives is the release of trismus. The surgeons thought that the short-term results of the release were successful but the long-term effect is unknown. This study was set up to aid future evidence-based treatment of trismus in noma patients.

Overall, the long-term result of trismus release is extremely poor. Only 39% of patients showed an improvement in the T

Competing interests

None declared.

Funding

Funded by Departmental sources of Department of Oral and Maxillofacial Surgery, Oral and Craniomaxillofacial Surgery, Radboud University Nijmegen, The Netherlands and Foundation Nijmegen University Fund, Radboud University Nijmegen, The Netherlands.

Ethical approval

Not required.

Acknowledgements

The authors specially thank Dr Adeniyi Semiyu Adetunji for his effort and support in accomplishing the research in Nigeria, Alhaji Nasiru Uba for translating and arranging the accommodation in the field, Abdullahi Hassa for driving us around through the rough areas for about 1900 miles and Abubakar Umar Gagi for searching the files in the hospital.

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