Midfacial Osteomyelitis in a Chronic Cocaine Abuser: A Case Report

Abstract

We describe the case of a 56-year-old man who was admittedfor treatment ofa progressive destruction ofhis hard palate, septum, nasal cartilage, and soft palate that had been caused by chronic cocaine inhalation. Biopsy of the bony septum revealed acute osteomyelitis and an extensive overgrowth of bacteria and Actinomyces-like organisms. There was no evidence of granuloma or neoplasm. The patient received intravenous ampicillin! sulbactam for 6 weeks, followed by lifetime oral amoxicillin. When there was no further evidence that destruction was progressing, the patient underwent nasal reconstruction with a cranial bone graft. The surgery was completed with no complications. To our knowledge, this is the first reported case ofmidfacial osteomyelitis associated with chronic cocaine abuse. The severity of this patient's complications, coupled with the success of his reconstructive surgery, makes this case particularly interesting. We believe that it is importantforphysicians to understand that septal perforation in a cocaine abuser should not be underestimated because it could result in a secondary bone infection. Nasoseptal destruction secondary to intranasal cocaine abuse is a result ofcocaine 's vasoconstrictive properties, and a decrease in the oxygen tension of intranasal tissue can facilitate the growth of anaerobic pathogens.

An overview of non-cardiac cocaine toxicity

“…These include: Wegener's granulomatosis, nasal lymphoma, localized infections, polymorphic reticulosis, and necrotizing granulomatous vasculitis (20,23,30,(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65).…”

Cocaine-related syndrome and palatal reconstruction: report of a series of cases

“…Many reconstructive procedures to repair palatal defects have been described, ranging from local or regional flaps, such as tongue, pharyngeal, buccal mucosa and temporalis flaps, to free tissue transfer [11][12][13][14][15][16][17][18][19][20][21][22][23] . In cocaine abusers both local and regional tissue transfers have limited use.…”

“…To date, only a few cases of palatal perforation from cocaine inhalation 3,9,14,16,21,22 have been reported in the literature, and an efficient management protocol is far from being established. Several reconstructive techniques of the palate and different surgical options have been reported.…”

Sinuorbital complications after intranasal cocaine abuse

“…3,4,[7][8][9][10] Interestingly, in these cases, the inferomedial orbit was involved, just as in the case presented here. Optic nerve involvement, in two cases bilateral, has also been reported.…”

“…The local anesthetic effect of the drug, which is applied more or less constantly in most cases, may conceal the disease from the patient for some time. [1][2][3] Septum perforation is the initial sign and may be followed by total septum loss, saddle-nose formation and atrophy of the turbinates. In the further course of the disease, inflammatory granulomatous tissue reactions may follow.…”