1. Necrotizing stomatitis in the developed world.
- Author
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Buchanan JA, Cedro M, Mirdin A, Joseph T, Porter SR, and Hodgson TA
- Subjects
- Aged, Analgesics, Debridement, Deglutition Disorders etiology, Deglutition Disorders therapy, Dietary Supplements, Gingivitis, Necrotizing Ulcerative therapy, Humans, Hypothyroidism diagnosis, Hypothyroidism therapy, Male, Malnutrition diagnosis, Malnutrition therapy, Metronidazole therapeutic use, Noma therapy, Parenteral Nutrition, Self Care, Stomatitis therapy, Thyroxine therapeutic use, Developed Countries, Gingivitis, Necrotizing Ulcerative etiology, Hypothyroidism complications, Malnutrition complications, Noma etiology, Stomatitis etiology
- Abstract
We present a case of a malnourished 68-year old man with occult hypothyroidism who presented with malaise, pyrexia, tongue swelling, oral ulceration and dysphagia after a 6-month period of increasing lethargy and failing self-care. Severe necrotic oral ulcerative lesions were accompanied by cutaneous purpura, blood-filled blisters and bedsores. It was concluded that the patient's clinical condition reflected necrotizing stomatitis on a background of malnutrition with scorbutic skin lesions and hypothyroidism. The patient made a good recovery with scrupulous oral hygiene, debridement, intravenous metronidazole and nutritional support. Healing occurred with marked fibrosis and trismus, which has slowly improved with mouth-opening exercises. Necrotizing stomatitis is more commonly encountered in malnourished children in developing countries, and may subsequently result in devastating facial defects and death. Patients in the developed world with poor oral hygiene, malnourishment and immunosuppression are also at risk, but early diagnosis and treatment is life-saving and reduces subsequent disability.
- Published
- 2006
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