Treatment of complications following orofacial gangrenous infection in a resource limited setting: Experiences and a proposed classification

Background: Orofacial gangrenous infection may result in a devastating acquired facial tissue defect which is often challenging to manage. Objective: We present our experience in the management of noma defects in a resource limited setting. Patients and Methods: All cases of noma that were surgically managed for secondary deformities at the oral and maxillofacial surgery unit of our hospital between 1991 and 2006 were retrospectively studied. Information retrieved included age, sex, site of orofacial gangrene, nature of orofacial defects, treatment given, duration of hospital stay and complications. Data retrieved was analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA). Results: A total of 21 patients were treated within the period reviewed and this consisted of 18 males and 3 females. Most patients (n=19, 90.5%) presented with defect involving both facial and oral tissues. The forehead and platysma flaps were the most commonly used flaps for soft tissue defect reconstruction. The duration of hospital stay ranged from 8 days to 120 days with a mean of 42.6 ± 27.7 days. One patient had reankylosis one year postoperatively. Conclusion: Orofacial gangrenous infection remains a threat to economically less developed countries such as in subSahara Africa. Its management is further complicated by the existing poor human and non human health resources in these environments. Emphasis should be on prevention, and an improvement in the current level of health resources to effectively manage these cases.