Clinical Pathologic Conference Case 2: Palatal Perforation

Oral changes in cocaine abusers: an integrative review

“… Cosola et al (2007) 27 Italy and Spain 6 29 to 46 M and F Case series Palatal perforation In all described cases, perforation of the nasal septum occurred first, followed by extensive destruction of the nasal and paranasal sinuses, with progression to palatal necrosis. Dovigi et al (2015) 28 USA 1 41 M Case Report Palatal perforation Midline destructive lesions induced by cocaine are a result of ischemic necrosis triggered by cocaine in a small subset of cocaine users, especially those who are predisposed to producing ANCA. Hofstede et al (2010) 29 USA 1 48 M Case Report Midline destructive lesions Palatal defects (erosion of the palate, nasal septum and inferior nasal turbinates) create functional difficulties related to speech and swallowing.…”

“…Regarding the type of study, of the 22 analyzed ones, 13 were case reports, 20 , 21 , 22 , 23 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 38 , 39 five were cross-sectional studies, 15 , 19 , 26 , 35 , 37 one was an experimental study, 24 two were observational studies, 26 , 35 and one was a field study. 25 Although literature reviews constituted an exclusion criterion, two studies 20 , 31 were included because they had more than one methodological type, being two case reports that contained literature reviews in their methodology.…”

“…Several oral alterations caused by cocaine abuse were identified in the studies, including palatal perforation, 20 , 22 , 26 , 27 , 28 , 29 , 31 , 33 , 34 temporomandibular disorders (TMD), 25 , 33 bruxism, 25 , 33 predisposition to periodontal diseases, mainly gingivitis, 24 , 25 , 26 , 35 damage to oral tissues, 19 , 24 presence of caries, 24 , 25 , 26 , 33 destructive lesions of the facial midline, 21 , 23 xerostomia 19 , 33 , 39 and ageusia. 24 …”

“…Among the methods of diagnosis used by professionals to identify oral diseases, anamnesis, 31 , 34 intraoral examinations, 20 , 22 , 23 , 25 , 29 , 32 , 33 , 35 head and neck computed tomography (CT), 21 , 22 , 23 , 28 , 31 , 32 , 33 histopathological examinations 19 , 32 , 38 and taste tests 24 were the ones mentioned.…”

Palatal perforation and chemical ulcers of the tongue in a blind patient

“…The compromised tissue is further irritated by the numerous adulterants typically found in the street form of the drug. The end result includes stasis of the mucociliary activity, crusting, and bacterial colonization, thereby leading to necrosis and ulceration . Silvestre et al.…”