How a Human Makes a Nose out of Nothing!

In Greek "nomein" is to devour. This is where Noma (Cancrum Oris) get its name from. It is a gangrene of the oral/nasal cavity due to a tissue infection in this area. It affects children under 5 who are malnourished or have recently had a systemic illness like measles. West Africa is the poorest area in the world and the population is not vaccinated, which contributes to this horrific disfiguring disease to exist. One of the patients asked a fellow nurse what the people in America do who have Noma, she had no answer because it doesn't exist in the developed world. It seems to be only in the poorest of populations where an infection can take a beautiful little girl and consume her nose, mouth and cheek, leaving her teeth exposed and holes in her face in place of a nose.

 

Here is Mama and her Uncle
After her first surgery



The disease begins as a sore inside the child's mouth or nose, the sore grows and consumes the soft tissue and occasionally bone and oral cavity. Infection or starvation will kill up to 90% of those infected. And those who do survive are social outcast due to the visible proof of evil that has cursed them the locals believe.

So how does the surgeon rebuild a face, and create a nose, cheek, and lips? Through grafts, and flaps!          

A skin flap is moving a section of skin and subcutaneous tissue from one part of the body to another. For example a little Girl we had, we will call here Mama, she had Noma when she was a couple months old, she was left with an open hole where her nose once was. The plastic surgeon in her first surgery took a 3 cm x 5 cm section from her forehead, kept it attached at one end (so it would still receive blood supply from the forehead) rotated the flap down over the area that will be the nose, and attached the opposite end to the face in hopes that the flap would take and become vascullarized from the new end that is attached. The hole in her forehead was closed. She was kept on the unit as the flap began to take, after 3 weeks she was able to return to the OR for the final stage. The flap was detached from her forehead and formed into a nose! It was covered with steristrips and we were all so excited to see what it would look like when reviled! In the end she has a round button nose! ?It is not a perfect nose, and when the Africa Mercy returns in the future she should return for follow up surgery to sculpt the nose into a more appealing shape. However, she has a nose!

 

This is Mama a few days before her Final
Surgery. You can see the scar on her
forehead where the flap
that is now her nose is connected



Mama was a very active child on our unit. She spoke a tribal language that none of the translators spoke, but her  uncle (who spoke french) was her caregiver. Although we couldn't speak her language we all got to know her and enjoyed playing memory, colouring, and cuddling with her. The day of her second surgery I had finished my morning rounds with my patients and as Mama's pre-medication Medazilone started to work she became a giggling ball of excitement laughing and screaming and throwing her self around, with the flap sitting on her face exposed if she were to fall it would be ruined and with her unable to be calm or still due to the medication there was only one solution! On my back she went, even though she was a tiny 5 year old, usually too big to be in a bumba (Mothers place the babies on their backs and wrap a piece of fabric to secure them in place). She was much calmer sitting on my back wrapped up. We bounced around and she played with my hair and let out giggles and a few yelps. For an hour until her surgery she remained tied to my back as i finished handing out patient morning meds. It has been a week and she has been discharged to the HOPE center (to stay until all fallow up appointments are finished, they are originally from Sinagel). Walking on the unit without Mama is an adjustment. No one is there to steel my pens, and wipe their face on my scrub top! I do hope to visit the hope center and see her before she heads home.

 

Today (April 16th) i did make it over to the Hope Center before lunch and here is the final picture of her new nose! It was so great to see her and play with her once again!