Palatal perforation is a lesion of various etiologies, including chronic intranasal abuse of cocaine. Only a few data, however, correlate this damage with heroin. The growing intranasal abuse of heroin and the fact that it is one of the five most popular drugs in most European countries, especially in the lower social classes, increase the need for further investigation of its effects on the oral cavity and nasopharynx. This report presents a case of chronic snorting of heroin, which caused perforation of the hard palate, the diagnostic approach, the selected surgical technique, the final outcome, as well as a review of literature.