Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia.

Noma is an infectious disease affecting mostly children aged 0-10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa's Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from the gums and progressively expanding into the cheek, nose, or eye regions. In an estimated 90% of cases, the disease is lethal as a result of systemic sepsis. For survivors, typical results are extensive defects of the cheek, nose, and periorbital and perioral regions. Due to the defects, extensive scarring is common, which leads to secondary problems such as growth alterations in an infant's skeleton due to inhibition and restraint of growth resulting typically in cicatricial skeletal hypoplasia. Other sequelae include trismus, partially caused by scarring or complete fusion between maxilla/zygomatic arch and mandible. The resulting overall disfiguring facial appearance results in patients being disabled and socially isolated. Methods: Facing Africa is a UK-based non-governmental organization that treats the secondary problems of Ethiopian noma survivors. Operations are performed in Addis Ababa by a visiting expert team. Postoperatively, patients are seen annually for years after the surgery. Results: This article discusses basic principles, goals, and a practical surgical algorithm for operating on lip, cheek, and oral defects, based on 210 noma patients who were operated on in Ethiopia over a period of 11 years. Conclusions: The suggested algorithm has proven to work for the Facing Africa team members and is considered shareware for all surgeons to use and benefit from.

Facial reconstruction in the developing world: a complicated matter.

Around the world there is a small industry of non-governmental organisations that provide health care in niche areas that cannot be met by national health care provision. One topic is facial deformity that can have a dramatic effect on quality of life. In this study we investigate the morbidity and outcome of a British surgical team working for a 2-week period in Ethiopia. Thirty-five patients who presented with facial deformities had 47 operations during a 2-week period. Data were recorded for a minimum of 3 weeks postoperatively. Operative techniques were classified as simple or complex. Postoperative complications were assessed and classified as major, intermediate, and minor. In addition, the character of each complication was recorded and the cause elucidated. After 3 weeks the clinical objectives had been achieved in 14/17 who had simple procedures but in only 5/18 who had complex operations (p=0.004). We conclude that complex procedures are technically possible within an under-privileged health care system but successful outcome depends on paying attention to multiple factors in patients' care and wound management. Early outcome studies may be a useful way to measure the quality of humanitarian surgical missions.

Review of management options for a retrobulbar hemorrhage.

This is a review of the current literature describing the different reported methods of managing a retrobulbar hemorrhage. The pathophysiology of the condition, together with its differing clinical presentations are described in length. Both the surgical and medical management are discussed. The importance of prompt recognition and treatment of the condition is emphasized. The consequences of unnecessary treatment delay are reinforced.