Cancrum oris is not uncommon in many developing countries. It is a gangrenous process of the mouth, which starts suddenly, rapidly involves the adjacent tissues of the face, quickly becomes well demarcated, and then spreads no further. It most often affects one or both sides of the jaw, and occasionally the front of the face (mouth, lips, nose, and chin). Fusiformis and Borrelia are largely responsible, but it is not contagious. It resembles Fournier’s gangrene of the scrotum, and may be associated with simultaneous extraoral gangrenous lesions of the limbs, perineum, neck, chest, scalp, or ear, etc.
Although cancrum oris can occur at any age, you will see it most commonly in a malnourished child between 1 and 5, whose general health has been further weakened by some infectious disease, usually measles, but also malaria, gastroenteritis, typhoid, whooping cough, tuberculosis or leukaemia, etc. Sometimes, there is no antecedent infection.
The lesion starts inside a child’s mouth, in association with acute ulcerative gingivitis, and then spreads to his lips and cheeks. The earliest stage, which is seldom seen, is a painful red or purplish-red spot, or indurated papule, on his alveolar margin, most often in his premolar or molar region. This lesion rapidly forms an ulcer, which exposes his underlying alveolar bone. If you see him at this stage, he has a sore mouth, a swollen, tender, painful lip or cheek, profuse salivation, and an extremely foul smell, with purulent discharge from his mouth or nose. Within the next 2 or 3 days, a bluish-black area of discoloration appears externally on his lips, or cheek. The gangrenous area is cone-shaped, so that much more tissue is destroyed inside his mouth, than his external wound might indicate. After separation of the slough, his exposed bone and teeth rapidly sequestrate.
Quite extensive superficial lesions can heal surprisingly well. But destruction of his deeper tissues, teeth and skeleton can produce such appalling disfigurement that you have to refer him for expert plastic surgery [md] if he is lucky. This may include: the correction of gross mutilation, ”dental anarchy’, trismus (particularly difficult) and a salivary leak. You can however treat him during the acute stage, as described below. Untreated cancrum oris is almost always quickly fatal, due to the associated illness (measles, typhoid, diarrhoea etc.) or a complication, such as septicaemia or aspiration pneumonia. Secondary haemorrhage is most unusual. And cavernous sinus thrombosis has never been reported.
