Lockjaw treatment after noma in the third world.
Surgical correction of post-noma-restricted mouth opening in Africa is of special difficulty. Multiple free-flap reconstruction to replace the missing oral mucosa lining is demanding, and postoperative rehabilitation is difficult to control. Physical treatment to open a post-noma lockjaw is of little success and often followed by relapse.Performing surgical reconstruction of facial defect in noma patients in Niamey, Niger, on a regular basis, we examined the possibility of distracting the scar formation between the jaws without surgical release to correct the lockjaw. The distraction was achieved with a bone distractor, originally prepared for distraction osteoneogenesis of the mandible. The questions were if the scar tissue is capable to be distracted 1 mm day by day until an acceptable opening of the mouth is achieved and what the long-standing results are after distraction mouth opening.A distraction therapy of the scar contracture between the upper and lower jaw using a three-dimensional bone distractor is a promising alternative. The mandible distractor applied between the arcus zygomaticus and the middle part of the mandible on both sides and distraction of 1 mm/d were successful in 2 cases in the long run and have been applied to 4 new cases during the last stay in Africa.
Holle
Jürgen
J
juergen@holle.at
D002648:Child; D002921:Cicatrix / Q000209:etiology* / Q000601:surgery*; D003906:Developing Countries; D005260:Female; D006801:Humans; D009548:Niger; D009625:Noma / Q000150:complications* / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000295:instrumentation*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014313:Trismus / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult