Generality
Gangrenous stomatitis (or name ) is a serious, rapidly progressive disease that originates from the mucous membranes of the mouth .
The causes are still poorly defined, but it seems that this condition is supported by an infection of the soft tissues of the face .
Typically, the disease begins within a single cheek or on the gums, with ulcerations, edema and spontaneous bleeding. These initial lesions degenerate rapidly and lead to a gangrene that tends to spread rapidly, penetrating into the tissues (including bones and teeth) and destroying them.
Gangrenous stomatitis affects mainly pre-school children, who live in the poorest countries of Africa .
The progression of the name can be interrupted with the use of antibiotics, improvement of nutrition and correction of dehydration. However, the effects of the degenerative pathological process are permanent and the repair of disfiguring scars necessitates the use of reconstructive surgery.
What's this
Gangrenosa stomatitis: what is it?
Gangrenous stomatitis is an infection capable of causing destruction of the soft and bony tissues of the face . This condition is generally preceded by debilitating diseases (eg exanthematous diseases, parasitic diseases, etc.) and mainly affects people who are immunosuppressed or who have a state of severe malnutrition .
Terminology and synonyms
- Gangrenous stomatitis is known in common jargon as a name (from the Greek " νομή ", which means ulcer). To indicate the pathology, the synonyms of " cancrum oris " and " aquatic cancer " are also used.
- A variant of the disease is localized to the genitals; in this case, the condition is called "noma pudendi" and first strikes the external organs of the reproductive system (such as the labia majora), then the neighboring tissues.
Causes and Risk Factors
Gangrenosa stomatitis: what are the causes?
The etiology of gangrenous stomatitis remains in part unknown, since the carrying out of in-depth medical studies in the regions most affected by the disease is problematic.
It has long been hypothesized that the underlying infection has a bacterial etiology . The scientific research available on gangrenous stomatitis has indicated, in fact, an important role in the disease of bacteria:
- Prevotella intermedia ;
- Fusobacterium necrophorum .
In the pathological process, these microorganisms ( Fusobacterium necrophorum and Prevotella intermedia ) seem to interact with one or more other pathogens (such as Borrelia vincentii, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Staphylococcus aureus and some non-haemolytic Streptococcus species), establishing a polymicrobial infection . The microorganisms responsible for gangrenous stomatitis probably derive from non-potable waters, polluted by animal faeces .
It should be emphasized that there is no known cause and the list of infectious agents mentioned above is only an estimate of the most probable etiological factors involved.
Noma: how much is still widespread in the world?
The exact prevalence of gangrenous stomatitis is unknown.
In industrialized countries, including the United States, the disease disappeared between the beginning and the middle of the 20th century, with improved hygiene and nutrition; as far as our continent is concerned, the last cases date back to the Second World War, during which the name was endemic in the concentration camps of Nazi Germany.
Gangrenous stomatitis is still present in the poorest countries in the world, particularly in Africa.
Gangrenosa stomatitis: who is most affected?
- Gangrenous stomatitis mainly affects children between the ages of 2 and 6 belonging to poor and hygienically poor social classes in some Asian and African countries .
- In Africa, Asia, some countries in South America and the Western world, rare cases of name have been described in adults with severe immunodeficiency (individuals with AIDS, myelopathy or being treated with immunosuppressants).
Gangrenosa stomatitis: aggravating and predisposing factors
Gangrenous stomatitis is often reported as a sequela of acute necrotizing gingivitis (note: when conditions are associated, the early sign is a lesion of the gingival mucosa).
Other predisposing factors can be:
- Malnutrition (in particular, lack of vitamins A and B);
- Concurrent or recent diseases, such as:
- Rubella;
- Malaria;
- Measles;
- Kwashiorkor;
- States of immunodeficiency (including AIDS);
- General hygiene deficiencies;
- Consumption of non-drinking water (or drinking water, but contaminated);
- Prolonged and close contact between men and neglected head of cattle or wild animals;
- Smoking habit.
Infection at the origin of gangrenous stomatitis can also be facilitated by local predisposing factors such as:
- Periodontal diseases;
- malocclusion;
- Poor oral hygiene.
Symptoms and Complications
Gangrenosa stomatitis: how does it manifest itself?
Gangrenous stomatitis begins with the appearance of a gingivitis and / or unilateral ulcer in the oral cavity ; usually, these lesions tend to degenerate quickly, extending from the cheek to the inside of the mouth.
Gangrenous stomatitis causes very severe damage, as it involves the destruction of the tissues of the face, up to making visible bones and teeth. The infection at its origin can also spread to the neighboring regions with respect to the mucous membranes of the oral cavity, such as the neck.
In addition to severe facial destruction, children with name often present:
- Spontaneous bleeding from the gums;
- Open renouncement;
- Halitosis;
- Excessive sialorrhea;
- Facial edema;
- lymphadenopathy;
- High fever.
The most debilitating sequela is the permanent constriction of the jaw, ie the partial or complete loss of the ability to open the mouth. This makes the intake of solid foods problematic, if not impossible.
Possible course
Without treatment, mortality related to gangrenous stomatitis is around 70-80% of cases.
Death is often due to complications such as:
- Generalized sepsis;
- Intracerebral septic emboli;
- Inanition (state of organic decay, effect of lack or insufficiency of nutrition).
Spontaneous resolution of the disease is associated with the formation of extremely dense and fibrous scars, which can lead to bone ankylosis between the mandible and maxilla or mandible and the malar bone. In survivors, the most serious disfigurements can be grounds for social exclusion.
Did you know that…
In some areas of Africa, gangrenous stomatitis continues to be considered a " curse ". Rarely, children are admitted to schools for fear of contamination (which, in reality, does not seem not to occur) and are often removed from their families and the village in which they live.
Diagnosis
The diagnosis of gangrenous stomatitis is essentially based on the assessment of predisposing risk factors and on the physical examination. The doctor can recognize the typical lesions of the gangrenous process with direct observation of the injured area.
Treatment
The progression of gangrenous stomatitis can be interrupted fundamentally with the timely use of antibiotics and the improvement of nutrition . Use of oral and maxillofacial surgery in combination with reconstructive plastic surgery is indicated for the repair of permanent damage.
Reconstruction is usually very demanding and should be delayed until complete recovery (approximately one year after the initial surgery).
Note. The delayed treatment will not allow a return to the previous condition of the disease: gangrenous stomatitis causes permanent and severely disabling disfiguring lesions. For this reason, it is essential to intervene in the initial phase of the name, when the damages are still limited. Unfortunately, the disease develops very rapidly and, in isolated regions, medical care is often required only when gangrenous stomatitis is advanced.
Gangrenosa stomatitis: which treatment is expected?
The treatment of acute gangrenous stomatitis is aimed at:
- Properly manage intrabuccal lesions with topical dressings;
- Improve the general health of affected individuals, with a balanced diet, vitamin supplements and sufficient hydration.
Furthermore, in this initial stage of the name, antibiotic-based therapy is recommended in order to:
- Avoid progression of the disease (if the lesions were still limited);
- Prevent the often lethal complications associated with infection;
- Limit the extent of injuries.
Surgical repair
Once the healing phase is complete, reconstructive surgery can be considered.
The goal is to alleviate stenosis of the mouth, so it involves the reconstruction of the mandible and maxilla, of the cheeks, lips and nose.
Surgery can also be used to improve function impaired by gangrenous stomatitis (elocution, salivary continence, etc.).
