Noma is a type of gangrene that destroys mucous membranes of the mouth and other tissues. It occurs in malnourished children in areas of poor cleanliness.
Cancrum oris; Gangrenous stomatitis
Causes, incidence, and risk factors
The exact cause is unknown, but may be due to bacteria called fusospirochetal organisms.
This disorder most often occurs in young, severely malnourished children between the ages of 2 and 5. Often they have had an illness such as measles, scarlet fever, tuberculosis, cancer, or immunodeficiency.
Risk factors include Kwashiorkor and other forms of severe protein malnutrition, poor sanitation and poor cleanliness, disorders such as measles or leukemia, and living in an underdeveloped country.
Noma causes sudden, rapidly worsening tissue destruction. The gums and lining of the cheeks become inflamed and develop ulcers. The ulcers develop a foul-smelling drainage, causing breath odor and an odor to the skin.
The infection spreads to the skin, and the tissues in the lips and cheeks die. The process can eventually destroy the soft tissue and bone. Eventual destruction of the bones around the mouth cause deformity and loss of teeth
Noma can also affect the genitals, spreading to the genital skin (this is sometimes called noma pudendi).
Signs and tests
Physical examination shows inflamed areas of the mucous membranes, mouth ulcers, and skin ulcers. These ulcers have a foul-smelling drainage. There may be other signs of malnutrition.
Antibiotics and proper nutrition helps stop the disease from getting worse. Plastic surgery may be necessary to remove destroyed tissues and reconstruct facial bones. This will improve facial appearance and the function of the mouth and jaw.
In some cases, this condition can be deadly if left untreated. Other times, the condition may heal over time even without treatment. However, it can cause severe scarring and deformity.
Calling your health care provider
Medical care is needed if mouth sores and inflammation occur and persist or worsen.
Measures to improve nutrition, cleanliness, and sanitation may be helpful.
Morelli, J. Disorders of the mucous membranes. In: Kliegman, ed. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 656.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.