DEFINITION OF CANCRUM ORIS
Cancrum oris , also known as noma or gangrenous stomatitis, is a severe and aggressive
gangrenous process (a condition wherein body tissues die due to infection or lack of blood supply)
that affects the mouth, nose, and lips.
INCIDENCE
This fatal disease is particularly prevalent among children in sub-Saharan Africa, with an
estimated frequency of 1 to 7 cases per 1,000 individuals.Noma is a fatal infection of the mouth
that mostly affects children between the ages of 1 and 16, with a peak incidence at ages 1 to 4.
STAGES OF NOMA
Stage I: Acute necrotizing gingivitis
This is the first stage of noma. The gums are red or reddish-purple and bleed spontaneously. The
child has fetid breath and may drool. Painful ulcers of the gums develop, causing trouble eating. If
the child is malnourished and has recently been sick with an infectious disease, such as measles
or chickenpox, they are at more risk for developing noma. Fever may develop at this stage. This
stage has an "indefinite duratio
Stage II: Edema
This stage begins the acute phase of noma. The telltale sign is facial edema (swelling) of the lips,
cheeks, eyes, etc. Ulceration of the gums worsens during this stage; ulceration may spread to the
mucosa (soft, mucus-producing tissue) of the mouth and nose. Fetid breath persists. The child
may feel pain or soreness in their mouth and cheeks. High fever is common at this stage. Drooling
persists. Lymphadenopathy (swollen lymph nodes) occur at this stage as well. The child may have
a decreased appetite and difficulty healing.
Stage III: Gangrene
This is also in the acute phase of noma. At this point, sequelae will inevitably set in. In this stage,
the infection eats away at the soft tissue of the child's face. The gangrene may affect the cheeks,
lips, nose, mouth, and nasal and oral cavities. The lesions have well-defined borders and a center
of black necrotic tissue. Surrounding skin will be discolored. The necrotic tissue sloughs away
over time, leaving holes in the face and the soft tissue. Bones and teeth may be exposed; there
may be a hole through the cheek. Facial gangrene will dry over time. The child is apathetic, has
little appetite, and has great difficulty eating.
Stage IV: Scarring
The acute phase is over by this point, but treatment is still recommended. This stage lasts one to
two weeks. The child may experience trismus (difficulty moving/opening the jaw), scars will form,
and any exposed teeth will set in place. Although the acute phase is over, the child's life is still at
risk.
Stage V: Sequelae
The disease is over by this point, but sequelae from the gangrenous and scarring stages remain.
Tissue may be missing, teeth may still be exposed, and the face is disfigured. Scar tissue has
grown in. The child may have difficulty eating, drinking, and speaking. The child may lose teeth;
teeth may also have become set in the wrong places. There may still be problems with drooling
and with opening/closing the jaw. Reconstructive surgery is an option at this phase.
CAUSATIVE AGENTS
• Fasobacterium Necrophorum
• Provotella Intermedia
RISK FACTORS
Some of the risk factors include;
~ Living in underdeveloped countries
~ Poor environmental sanitation
~ Poor oral hygiene
~ Malnutrition
~ Frequent exposure to human/animal feces
~ Prior history of viral or bacterial infections
SIGNS AND SYMPTOMS
The typical signs and symptoms of noma include;
~ Swollen gum
~ Swollen cheek lining
~ Ulcer formation
~ Greyish color of the oral cavity
~ Edema with foul-smelling drainage
DIAGNOSTIC INVESTIGATION
The diagnostic investigations include;
• Physical Examination
• X-rays
• CT scans
• MRI
• Bacterial culture analysis using oral swabs.
• Blood tests
TREATMENT
-Medical
• Administration of systemic antibiotics I.e penicillin in combination with metronidazole or
streptomycin.
• Supplementation with folic acids,irons and vitamin B complex
• Mono therapy with metronidazole
• Plastic Surgery to reform facial bones
- Nursing Management
• Maintaining proper electrolytes balance
• Maintaining proper oral hygiene
• Encourage client to take food rich in proper nutrition
• Wound debridement
•h Encourage te client to maintain personal hygiene
Complications
• Facial deformity
• Discomfort
• Difficulty eating and drinking
•Difficulty in speaking
• Social isolation
PREVENTION
Noma can be prevented in following ways;
• Promotion of national awareness of the disease
• Creation of employment to reduce poverty
• Promotion of exclusive breast feeding in the first 3- 6 months of life
• Timely immunization against childhood diseases
• Improved nutrition
GROUP MEMBERS
• NMTCKTRGN210099
• NMTCKTRGN210013
• NMTCKTRGN2100
• NMTCKTRGN2100
• NMTCKTRGN2100
• NMTCKTRGN2100
• NMTCKTRGN2100
• NMTCKTRGN2100