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NOMA occurs in young children who are malnourished and debilitated by diseases like measles and malaria. The early stages of noma are characterised by a swelling of the cheek and/or lip, excessive salivation and pain. Within a few days, the cheek and lip discolour and the mouth becomes extremely foul smelling. Teeth become loose. Within a week, the skin of the cheek and/or lip is perforated and the gangrene of the facial tissue spreads very rapidly to the jaws, nose and eyes.