CASE REPORT Journey of a Noma Face.

OBJECTIVE: Noma, or cancrum oris, is rare in developed countries. Surgeons are likely to encounter this disease only in the context of a medical mission. While it is tempting to approach noma sequelae as an oncologic resection, an understanding of the disease process will reveal that the challenge is quite different. In addition, unlike the oncologic patient who desires rapid return to an aesthetically normal facies, the adult noma patient with chronic history of noma sequelae may be more accepting of a functional but less aesthetic outcome. METHODS: We describe a noma patient with soft-tissue losses involving right cheek, nasal ala, upper lip and oral commissure, and severe trismus who underwent staged reconstructive surgery. RESULTS: The objectives of temporomandibular joint release, facial defect coverage, correction of occlusal cant, and restoration of lower facial symmetry were met. The final planned stage of reconstruction was declined as the patient had regained sufficient self-confidence to participate in social activities. CONCLUSIONS: Surgeons from developed countries rarely encounter adult patients with noma sequelae. While reconstructive principles remain the same, noma reconstruction must be approached differently from oncologic resection and a staged approach is often necessary. Although complete correction may be planned to restore function and aesthetics, the noma patient may eventually be satisfied with a functional but less aesthetic outcome.

Modified technique for frontal sinus obliteration using calvarial bone and Tisseel glue.

BACKGROUND: Frontal sinus obliteration is indicated in trauma and frontal sinus disease. We present our experience with a modified technique of frontal sinus obliteration. METHODS: We reviewed the records of 17 patients who underwent frontal sinus obliteration with a combination of Tisseel fibrin glue (Baxter Healthcare Corporation, Deerfield, IL) and calvarial bone and describe our technique. RESULTS: One female and 16 male patients (mean age, 36.6) underwent frontal sinus obliteration from 2001 to 2005. Traumatic fracture was the most common indication. The patients were followed up for a median of 15 months. There were no major complications. Postoperatively, one patient developed a localized frontal wound infection at 3 weeks; this resolved with debridement. At latest follow-up, all were free from local sinus complications, disease recurrence, headaches, or intracranial events. CONCLUSIONS: The combined use of autogenous calvarial bone and Tisseel is suitable for frontal sinus obliteration. Our technique is associated with low donor site morbidity, avoids a separate donor surgical site, and has a low complication rate.