The mutilations resulting from a noma are varied. The most dramatic cases involving complete destruction of mid-facial bone and soft tissue structures represent a major challenge for the plastic surgeon. Based on his experience over the last twenty years, the author reports the most useful and valuable methods of reconstruction used by his team in more of a thousand operations performed in Africa and in Switzerland. Minor defects can be treated by most plastic surgeons having an experience with cleft surgery. However, complicated cases require an expertise in cranio-maxillo-facial surgery, microsurgery and anaesthesia which can only be performed by a medical team accustomed to treat cervico-facial tumors or cranio-facial malformations.