Noma: the Sokoto approach

Abstract 

On October 1996 a Dutch-German medical team spent three weeks in Sokoto, Nigeria to initiate a surgical aid program for the treatment of noma. For logistic reasons a semiquantitative classification system for noma was devised, describing the extent of tissue loss of anatomical units such as the nose, the outer cheek and the inner lining of the cheek, the upper lip and lower lip, and the degree of trismus (NOITULP). This system proved useful in planning the operations of the 23 noma patients treated during this period and may be helpful for future evaluation of postoperative results and the development of standardized treatment. For patients with severe trismus an intubation strategy was developed. If two attempts at blind intubation had failed, the policy was: quick cutting of the scar tissue supposedly causing the trismus and intubation (QCI). If this approach failed a Seldinger minitracheostomy was performed. In eight patients with severe (T3, T4) trismus this procedure was performed. In three patients a minitracheostoma was necessary. The operative procedures consisted of a large variety of local flaps. Forehead flaps and cervical rotation flaps were used most frequently. In four patients wound healing was complicated necessitating additional surgical treatment.