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Research Letter
AAFPRS Research Award Winner
April 12, 2018

Evaluation of the Noma Disease Burden Within the Noma Belt

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
  • 2Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
  • 3Department of Otolaryngology, University Teaching Hospital Kigali, University of Rwanda College of Medicine & Health Sciences, Kigali, Rwanda
  • 4Department of Oral and Maxillofacial Surgery, Katharinen Hospital, Stuttgart, Germany
  • 5Children’s Noma Hospital, Sokoto State, Nigeria
  • 6Department of Anaesthesia and Critical Care, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
  • 7Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 8Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana
JAMA Facial Plast Surg. Published online April 12, 2018. doi:10.1001/jamafacial.2018.0133

Noma is a relatively unknown but devastating opportunistic infection of the face that occurs in the setting of extreme poverty. Noma cases are concentrated within the “noma belt,” a region that extends from Senegal to Ethiopia where malnutrition is endemic.1 Acute noma begins in the gingiva as a necrotizing lesion, progressing rapidly through the hard and soft tissues of the face (Figure 1).2 Untreated noma carries a 90% mortality rate.3,4 Survivors are left with complex facial deformities in a low-resource setting (Figure 2).5

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