Prospective Outcomes of Noma Facial Reconstructive Surgery in Sokoto, Nigeria.
Mohana AmirtharajahMichael OlaleyeBukola OluyideAnnick LengletCono AritiElise FarleyRyan WintersAbdurrazaq Olanrewaju TaiwoDavid A ShayePublished in: Facial plastic surgery & aesthetic medicine (2024)
Background: Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations. Objective: To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria. Methods: Objective outcomes were recorded using the noma-specific NOITULP (nose, outer cheek, inner cheek, trismus, upper/lower lip, particularities) classification system. PROs were recorded using a locally developed tool. Postsurgical changes were assessed by Wilcoxon signed-rank testing. Linear regression was used to look for associated risk factors. The inter-rater reliability (IRR) of the NOITULP score was assessed using the weighted kappa statistic. Results: Forty-nine patients (median age 25 years, 71% male) underwent local/regional flap reconstruction and/or trismus release. Twelve complications were reported. Univariate analysis showed a 3.20 change in PRO score (95% confidence interval 0.59 to 5.81, p = 0.018) per kilogram the patient underwent at time of surgery. The NOITULP score improved from a presurgery median of 3.5 to 2.3 ( p < 0.0001), however, the IRR was poor (kappa = 0.0894, p < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 ( p < 0.0001). Conclusions: Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria. Clinical Trial Registration: OCA017-63.
Keyphrases
- minimally invasive
- coronary artery bypass
- patient reported outcomes
- clinical trial
- surgical site infection
- end stage renal disease
- nuclear factor
- soft tissue
- newly diagnosed
- magnetic resonance
- chronic kidney disease
- ejection fraction
- study protocol
- peritoneal dialysis
- randomized controlled trial
- toll like receptor
- metabolic syndrome
- immune response
- adipose tissue
- open label
- drug induced
- genetic diversity