Hard palate perforation in cocaine abusers: a systematic review

Abstract

Cocaine abuse has increased in the past decade, with a rise in the reported cases of midpalatine perforations produced as a result. The vasoconstrictive and caustic effect of the drug can produce direct irritation and ischemia of the nasal and palatine mucosa, leading over the long term to the creation of an oronasal perforation secondary to maxillary bone destruction. The present study offers a systematic review of all the clinical cases of necrotic nasopalatine perforations attributed to inhaled cocaine documented in the PubMed literature database. The main clinical characteristics of the disorder and its different management options are examined. Likewise, emphasis is placed on the importance of a correct differential diagnosis with respect to other conditions also characterized by midfacial necrotic destruction. Of the 36 cases included in the study, 21 corresponded to females and 15 to males. Most of the lesions were located in the hard palate (77.7%) with only 5.5% being found in the soft palate. Combined hard and soft palate presentations in turn accounted for 16.6% of the cases. The mean diameter of the perforation was 19.32 ± 16.94 mm (95%CI: 11.81-26.83). The most frequent clinical manifestation was rhinolalia together with the regurgitation of solid food and liquids through the nares. Management consists of a combination of antibiotics, analgesics, prostheses (obturators), and surgical reconstructions of the defect.

Clinical Pathologic Conference Case 2: Palatal Perforation

“…Drugs such as cocaine when insufflated (snorted) can produce the type of defects presented due to localized vasculitis and ischemia. [1][2][3][4][5] The patient did not report his previous history of cocaine abuse at this initial visit and admitted to it only after initial diagnostic radiographs were obtained.…”

Craniovertebral junction instability as an extension of cocaine-induced midline destructive lesions: case report

“…17 The strong tendency of the damaged nasal mucosa to form tightly adhering scabs prompts affected patients to remove these scabs, often by using further damage-inducing mechanical methods. 16 Frequency, severity, and tenacity of bacterial superinfections of the damaged nasal mucosa may be related to the severity of the underlying mucosal damage as well as to individual nasal hygiene and antimicrobial treatment patterns. Bacterial superinfection has been documented in essentially all patients with CIMDL.…”

“…Con- sequently, in clinical practice, both immunofluorescence and antigen-specific solid-phase assay testing need to be performed in parallel when differentiation of CIMDL from GPA is sought. [14][15][16][17][18][19][20][21][22] The pathogenesis of CIMDL remains poorly understood. Vascular ischemia from excessive cocaine use is widely considered to be a major element in the development of CIMDL.…”

Repair of Cocaine-Related Oronasal Fistula With Forearm Radial Free Flap

“…6 When palatal perforations take place, the patients typically complain of a number of symptoms such as regurgitation of food and liquids in the nose, rhinolalia, anosmia, pain, and halitosis. 7 These symptoms usually bother the patients who ultimately seek help.…”