Redefining the severity of orofacial tissue damage caused by noma: a novel classification approach.

Background: Noma is a severe orofacial disease with high mortality and morbidity. Although severity scales exist, they fail to fully capture the extent of damage caused by the disease.

Methods: This study analysed 404 photos of 260 noma cases from Facing Africa (n=228) and Project Harar (n=32) to create a new severity classification system. Photos were displayed on a large screen for better visualization. Tissue damage was assessed in terms of width, depth and surface area using the American Burn Association's grading system. A mathematical formula was also developed to quantify the extent of noma-induced orofacial damage.

Results: Fifteen orofacial anatomical units vulnerable to noma were identified, leading to the development of a new severity classification system that enhances the assessment of noma. This system evaluates tissue damage qualitatively as minor, moderate or major and quantitatively using a purpose-built mathematical formula.

Conclusions: Current classification systems inadequately capture noma severity due to vague definitions and limited consideration of the affected anatomical units. The new approach addresses these gaps by considering all tissue damage, including dentition, and allows for precise qualitative and quantitative assessment of disease severity. Continued research and validation are essential to refine this method, improving its clinical and research applications and enhancing outcomes for noma patients worldwide.