British Journal of Oral and Maxillofacial Surgery (2004) 42, 267—269 SHORT COMMUNICATION Cancrum oris Anil George Behanan* , Ajith Auluck, Keerti Latha Pai Department of Oral and Maxillofacial surgery, College of Dental Surgery, Manipal Academy of Higher Education, Manipal-576 104, Karnataka, India Accepted 13 February 2004 KEYWORDS Gangrenous stomatitis; Noma; Extraoral ulcer Summary A malnourished 9-year-old boy presented with an infection in the buccal space that developed into cancrum oris during the course of treatment. © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Introduction Cancrum oris is also known as noma or gangrenous stomatitis. Over the years, the mortality has declined from 80 to 90% to current 8—10% 1 as a result of antibi- otics. The disease occurs mainly in children in areas where poverty is life and hygiene is poor. Case report A 9-year-old boy presented with a 4cm × 6cm tender swelling on the right cheek. It had started 3 weeks previously and there was no history of trauma. The skin over the swelling was tense and glossy and there were encrustations at the an- gle of mouth.. There was infra-orbital cellulitis and pus was discharging from angle of mouth. (Fig. 1). The right submandibular lymph nodes were en- larged and tender. There was at that time no foul odour or signs of necrosis. *Corresponding author. Tel.: +91-820-2574133; fax: +91-820-2571966. E-mail addresses: agbehanan@rediffmail.com, agbehanan@yahoo.co.in (A.G. Behanan). Inside the mouth there was a 2 cm ulcer on the right cheek that extended backwards from the cor- ner of mouth. The boys growth was stunted, he was malnour- ished and had intermittent fever of 39 ◦ C. There were signs of chronic lung disease. An orthopantomogram showed no bony changes. On the first day, we incised and drained the swelling by an intraoral approach and patient was given amoxicillin 500mg three times daily and metronidazole 400mg twice a day. On the 7th day skin over the right cheek began to show signs of necrosis with crater-like erosions (Fig. 2). We di- agnosed gangrenous stomatitis secondary to the infection of buccal space and the antibiotic regi- men was changed. We gave injections of penicillin 10,000IU 6 hourly, gentamicin 30mg intravenously every 12h and vancomycin 125mg intravenously every 6h. We also gave metronidazole 200mg and ciprofloxacin 500mg three times a day. We gave the boy a high protein diet and vitamin supplements. Laboratoryinvestigationsincludedahaemoglobin concentration of 6.0 g/dl and a packed cell volume of 21.3. Bleeding tests were within the reference ranges and ELISA for HIV showed no infection. Culture of pus showed that the organisms was sensitive to gentamicin and ciprofloxacin. Fluores- cence microscopy showed no acid fast organisms. The lesions were kept clean by repeated irri- gation with saline and hydrogen peroxide. Ribbon 0266-4356/$ — see front matter © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjoms.2004.02.018