Noma Beyond Childhood: Dual-Flap Reconstruction of Orofacial Necrotising Infection in an Immunocompromised Elderly Male Patient

Cancrum oris (noma) is a rapidly progressive orofacial gangrenous infection predominantly described in malnourished children. Its occurrence in immunocompromised elderly adults is rare, diagnostically challenging, and associated with high mortality rates without timely intervention. We report a case that highlights the general surgical principles governing its recognition and management. A 73-year-old man presented with a one-month history of right cheek swelling, ulceration, and trismus. Examination revealed an indurated, ulcerated lesion with purulent discharge and necrotic margins. Serial surgical debridements were performed, guided by culture-directed antibiotic therapy and concurrent nutritional rehabilitation. Definitive reconstruction was achieved with a right buccal mucosal advancement flap and cheek rotational fasciocutaneous flap. This case reaffirms that noma must be considered in elderly immunocompromised patients presenting with orofacial necrosis. A structured surgical strategy that includes aggressive debridement, broad-spectrum antimicrobial therapy, nutritional optimization, and staged locoregional reconstruction is the determinant of survival and functional recovery.