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The surgical management of extra-articular ankylosis in noma patients.
Journal article

The surgical management of extra-articular ankylosis in noma patients.

  • Rüegg EM Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. Electronic address: Eva.Ruegg@hcuge.ch.
  • Baratti-Mayer D Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
  • Jaquinet A Division of Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
  • Montandon D Plastic, Reconstructive and Esthetic Surgery, Route de Florissant 112, 1206 Geneva, Switzerland.
  • Pittet-Cuénod B Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
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  • 2018-08-15
Published in:
  • International journal of oral and maxillofacial surgery. - 2018
ankylosis
cancrum oris
coronoidectomy
free flap
noma
trismus
Ankylosis
Burkina Faso
Child
Female
Humans
Male
Niger
Noma
Physical Therapy Modalities
Reconstructive Surgical Procedures
Retrospective Studies
Surgical Flaps
Treatment Outcome
English Extraarticular ankylosis occurs frequently in children suffering from noma sequelae. Over 20years of operating on these patients, we observed high recurrence of mouth opening limitation. We therefore progressively changed our surgical strategy. This retrospective study compares the impact of different parameters (types of surgery, noma type, physiotherapy compliance, age and sex) on immediate and long-term mouth opening. It includes a series of 121 patients with extraarticular ankylosis operated on between 1990 and 2015. Soft tissue reconstruction evolved from local and pedicled flaps to large free flaps. Mouth opening was performed by bone-bridge excision, sometimes associated to contralateral coronoidectomy. Mouth opening technique including bilateral coronoidectomy with free flap reconstruction was the only independent factor for significantly better immediate mouth opening with a mean increase of 8.7mm [95% confidence interval (CI) 4.3-13.1, P<0.001) and this effect was maintained in the 3years of follow-up. Another positive factor related to long-term results was excellent physiotherapy, while noma type 4 was a negative factor. Recurrence remains problematic in the management of noma sequelae. If physiotherapy and long-term follow-up cannot be offered, patients should not be operated on, because if limitation of mouth opening recurs, oral feeding may become impossible when a facial defect has been reconstructed.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.rero.ch/global/documents/131006
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