Noma – gangrenous tissue destruction of the face
Noma, also known as cancrum oris or gangrenous stomatitis, is a gangrenous disease leading to tissue destruction of the face, especially the mouth and cheek.
Noma was observed in Nazi concentration camps in World War II, and was studied by Nazi physician Josef Mengele. In many cases a recent debilitating illness, usually measles and sometimes herpes simplex, varicella (chicken pox), scarlet fever, malaria, tuberculosis, gastroenteritis or bronchopneumonia, precedes the appearance of noma as well as cancers such as leukemia. In many instances the infection begins as necrotizing ulcerative gingivitis (NUG). Early presentation is unclear as noma is often well progressed at initial presentation.
Noma, unlike most infections, is able to spread through anatomic barriers such as muscle.
In the developed world, noma has virtually disappeared except for an occasional case related to immunosuppressive conditions such as HIV infection, severe combined immunodeficiency syndrome, or intense immunosuppressive therapy. The World Health Organization (WHO) estimates the global yearly incidence to be approximately 140,000, of which 100,000 are between 1 and 7 years old and living in sub-Saharan Africa.
The mucous membranes of the mouth develop ulcers, and rapid, painless tissue degeneration ensues, which can degrade tissues of the bones in the face.
The disease is associated with high morbidity and mortality and mainly affects children under the age of twelve in the poorest countries of Africa.