PRASHANTA SHRESTHA GA-2, 528 Kamalpokhari Kathmandu, Nepal Telephone: 977-1- 4410060, 9851035915 E mail: firstname.lastname@example.org Academic Qualifications: BDS, Dr Dent Medicine, PhD (Asahi University, Japan) Professional Registration: Specialist in Oral and Maxillofacial Surgery (Nepal Medical Council) Present appointment Associate Professor, Division of Oral and Maxillofacial Surgery, Kathmandu University Medical School, B and B Hospital, Kathmandu, Nepal Director, National Center for Oral and Maxillofacial Surgery, The Rotary Foundation Project at National Dental Hospital, Kathmandu, Nepal Immediate Past Appointments Research Associate, Department of Oral and Maxillofacial Surgery, Asahi University, Japan (1991-1996) Visiting Teaching Fellow at the Faculty of Dentistry, University of Malaya, Malaysia (1997). Major Publications Author and coauthor to more than 50 research papers on oral carcinomas, salivary gland tumors and odontogenic tumors published in various International Journals from the UK, Germany, France, Denmark, Greece, Bangladesh, Malaysia, Japan and USA. Author of a book on carcinogenesis and extra cellular matrix proteins in tumors and carcinomas from RG Landes, Austin, Texas, USA (1997)and co-author of a book on S100 proteins in human tumors in a series of experimental tumor research published from Asahi University Publications, Japan (2002) Clinical and Research interest Craniofacial anomalies including cleft lip and palate, oral mucosal lesions, oral carcinoma and salivary gland tumors, oral and maxillofacial pathology and reconstruction surgery Professional Associations and affiliations Member of the council of the Asian Association of Oral and maxillofacial Surgeons Member, American Cleft-Palate Association Fellow of International Association of Oral and Maxillofacial surgeons Life member of Nepal Medical Association, Nepal Dental Association and Indian Association for Cancer Research Guest speaker in a number of international and national meetings and various universities in Bangladesh, India, Thailand, Malaysia, Taiwan, South Korea, Vietnam, Cambodia, Japan, Canada, UK and USA Reconstruction Surgery for Correction of the Deformity in the Maxillofacial Region due to Cancrum Oris (Noma). Prashanta Shrestha, PhD (Japan) Division of Oral and Maxillofacial Surgery B and B Hospital, Kathmandu University Teaching Hospital, Kathmandu University Medical School and National Center for Oral and Maxillofacial Surgery, Kathmandu, Nepal Noma, or Cancrum oris, is a gangrenous stomatitis and was known to the human civilization since the time of Hippocrates, Galen and Celcius. The term, cancrum oris (noma) was used to describe the disease in 1848 which is derived from the Greek, nome, meaning “to devour”. The disease, however, has been largely disappeared, except with rare exceptions, from countries in North America and Western Europe. But in parts of Asia, Africa and South America, the disease is still seen and affects mostly children. The presentation describes our experience of treating eight patients presenting with Noma, since January 2003 in Nepal and had presented with a deformity either of the soft tissue or along with the bony skeleton in the maxillofacial region and the reconstruction of which often involved multiple procedures and was a real challenge to the clinician. It is difficult assess the frequency and the nature of onset of the disease as we have not seen the acute phase of the disease being presented to us. These patients had their disease during their childhood and they lived in remote areas of this mountainous country. Their age at the time of presentation ranged from 12 to 52 years, 3 males and 5 females. The acute phase of the disease, in all patients dated back to their childhood – ranging from 6-12 years when they had a painful swelling, ulceration followed and over a course of several days, blue and black area appeared on the skin of cheek, lips or nose and sloughing of the tissues left deep and perforating wounds. The teeth were exposed except in one. Healing then occurred with fibrosis and scar tissue formation leaving loss of parts of lips, nose, alveolar bone or teeth and constriction and deformation of the affected area resulted in a considerable deformity in the maxillofacial region. One had fusion of the coronoid process of the mandible with the posterior maxilla leading to complete inability to open the mouth. During the acute phase of disease, usually predisposing predisposing factors such as exanthematous fever, malnutrition, several infectious diseases or poor oral hygiene may have a role which, however, could not be elicited in our series of patients. At the time of presentation, no acute form of the disease was seen and the patients were clinically healthy, with no malnutrition or chronic illness or other infections and complete blood counts within acceptable limits that did not contraindicate surgery under general anesthesia. All patients had surgery under general anesthesia. Local flaps were used to reconstruct the upper lip and angle of the mouth defects. In one a defect on the angle of the mouth which was quite extensive, a deltopectoral flap was used for coveting the defect. All nasal deformity was reconstructed using nasolabial and/or fore-head flaps. The post operative healing was uneventful in all the cases and a reasonably satisfactory reconstruction of the deformity resulting from noma was achieved by the use of local or distant pedicled flaps and multiple surgical procedures and revisions were necessary.