Are Noma and Cancrum Oris the Same Disease?
Yes, Noma and Cancrum Oris are identical terms referring to the same devastating orofacial gangrenous disease. These are simply different names for the same clinical entity, with "cancrum oris" being the Latin medical terminology and "noma" being the more commonly used modern designation 1, 2, 3.
Terminology and Historical Context
The disease has been known by multiple synonymous names throughout medical history, including necrotizing ulcerative stomatitis, stomatitis gangrenosa, water canker, and cancrum oris, but all refer to the same condition now most commonly called noma 2, 3.
Dutch surgeons in the 16th and 17th centuries recognized that the popular term "water canker" was insufficient and distinguished this rapidly spreading facial ulceration in children as a distinct clinical entity different from cancer 2.
The terminology evolved over centuries, but the clinical presentation, pathophysiology, and devastating consequences have remained consistent across all historical descriptions 2, 4.
Clinical Definition
Noma (cancrum oris) is a gangrenous infection that develops in the mouth and spreads rapidly to destroy orofacial tissues and neighboring structures 1, 3.
Key Clinical Features:
Early signs include excessive salivation, marked fetor oris (severe halitosis), facial edema, and grayish-black discoloration of affected skin 1.
Tissue destruction may involve the cheek, chin, infra-orbital margin, palate, nose, antrum, and virtually any facial structure 1, 5.
Pathophysiology involves polybacterial infection with secondary ischemia, leading to necrotizing fasciitis, myonecrosis, and osteonecrosis 5.
Epidemiology and Risk Factors
The disease predominantly affects children aged 2-16 years in sub-Saharan Africa, with an estimated frequency of 1-7 cases per 1,000 children in affected communities 1, 3.
Global yearly incidence is approximately 140,000 cases with a mortality rate of 70-90% without appropriate treatment 2, 3.
Primary Risk Factors:
- Poverty and malnutrition are the fundamental underlying conditions 1, 2, 3.
- Poor oral hygiene and deplorable environmental sanitation 3.
- Debilitating systemic diseases including measles, malaria, tuberculosis, and HIV infection 1, 3, 5.
- Close residential proximity to livestock 3.
Pathogenesis
Acute necrotizing gingivitis (ANG) is considered the antecedent lesion that precedes noma development in the vast majority of cases 3, 5.
Evolution from ANG to noma requires infection by a consortium of microorganisms, with Fusobacterium necrophorum and Prevotella intermedia suspected as key bacterial players 3.
Malnutrition acts synergistically with endemic infections to promote an immunodeficient state, with weakened immunity as the common denominator 3.
Rarely, noma can arise without any preceding oral lesions being observed, though this is uncommon 5.
Important Clinical Caveats
Noma is not recurrent and is not transmissible between individuals 5.
Survivors face severe functional impairment including trismus, oral incontinence, speech problems, and devastating facial disfigurement 2, 3.
The disease disappeared from Western countries in the late 19th century due to economic progress that allowed adequate nutrition for children, not due to medical advances 2, 4.
Effective antimicrobial drugs (sulfonamides and penicillin) and adequate surgical reconstruction techniques exist but remain inaccessible to most victims due to extreme poverty 2.