title: CASE REPORT Journey of a Noma Face.
abstract: OBJECTIVE
  Noma, or cancrum oris, is rare in developed countries. Surgeons are likely to encounter this disease only in the context of a medical mission. While it is tempting to approach noma sequelae as an oncologic resection, an understanding of the disease process will reveal that the challenge is quite different. In addition, unlike the oncologic patient who desires rapid return to an aesthetically normal facies, the adult noma patient with chronic history of noma sequelae may be more accepting of a functional but less aesthetic outcome.
  
  
  METHODS
  We describe a noma patient with soft-tissue losses involving right cheek, nasal ala, upper lip and oral commissure, and severe trismus who underwent staged reconstructive surgery.
  
  
  RESULTS
  The objectives of temporomandibular joint release, facial defect coverage, correction of occlusal cant, and restoration of lower facial symmetry were met. The final planned stage of reconstruction was declined as the patient had regained sufficient self-confidence to participate in social activities.
  
  
  CONCLUSIONS
  Surgeons from developed countries rarely encounter adult patients with noma sequelae. While reconstructive principles remain the same, noma reconstruction must be approached differently from oncologic resection and a staged approach is often necessary. Although complete correction may be planned to restore function and aesthetics, the noma patient may eventually be satisfied with a functional but less aesthetic outcome.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: Colin Yi-Loong
authors.initials: CY
authors.lastname: Woon
authors.forename: Karen Wei-Ee
authors.initials: KW
authors.lastname: Sng
authors.forename: Bien-Keem
authors.initials: BK
authors.lastname: Tan
authors.forename: Seng-Teik
authors.initials: ST
authors.lastname: Lee