Clinical Features and Pathogenesis of Noma: A Narrative Review Highlighting the Emerging Strategies for Prevention and Management

Noma, also known as cancrum oris, is a rapidly progressive gangrenous infection that affects the oral and facial tissues of malnourished children in impoverished regions, particularly in sub-Saharan Africa. The disease typically begins as acute necrotising gingivitis and rapidly progresses to extensive tissue destruction, facial disfigurement, and high mortality if left untreated. This narrative review explores the clinical progression of Noma, its World Health Orgnisation (WHO) classification and simplified staging systems, the pathogenesis involving malnutrition, immunosuppression, and microbial dysbiosis, as well as the polymicrobial nature of the disease. Diagnosis of Noma is primarily clinical, although emerging microbiome-based diagnostic techniques show promise for early detection. Management requires a comprehensive approach that combines early antibiotic therapy, nutritional rehabilitation, wound care, and delayed reconstructive surgery. Preventive strategies include adequate vaccination (particularly against measles), community-based oral health education, and improvements in Water, Sanitation, and Hygiene (WASH) initiatives. Strengthening local healthcare infrastructure and establishing sustainable surgical programmes are essential for long-term control and rehabilitation of Noma. Addressing the socio-economic determinants of Noma through holistic public health efforts remains crucial for reducing its burden and achieving global eradication.