Cocaine abuse occasionally causes extensive destruction of the osteocartilaginous structures of the nose, sinuses and palate, which mimics the clinical picture of other diseases associated with necrotising midfacial lesions. The differentiation of cocaine-induced midline destructive lesions (CIMDL) and limited granulomatosis with polyangiitis (GPA) may be difficult, particularly if patients do not readily admit substance abuse. We studied 10 patients with CIMDL and palate perforation referred to our Unit between 2002 and 2015. All cases underwent nasal endoscopy, sinus CT or MRI and ANCA test. In 8 patients, a nasal biopsy was performed. The PubMed database was searched to review all cases of palate perforation described in patients affected by CIMDL or GPA. All 10 cases presented with septal perforation and inferior turbinate destruction. We found hard palate perforation in 7 patients, soft palate perforation in 2 patients, and perforation of both in one patient. ANCA testing was negative in 8 patients and positive in 2, with C-ANCA and P-ANCA specificity, respectively. A review of the English literature identified palate perforation in 5 patients with GPA and in 73 patients with CIMDL. The presence of palate perforation in patients with MDL may represent a clinical marker that strongly favors CIMDL over GPA.
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| http://dx.doi.org/10.14639/0392-100X-1586 | DOI Listing |
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Article Synopsis
- Cocaine consumption, especially in its snorted form, has increased cases of serious nasal and palatal tissue damage known as cocaine-induced midline destructive lesions (CIMDLs), affecting individuals with a history of psychiatric issues.
- Four patients exhibited severe tissue loss in the hard palate center, with lesions averaging between 2.3 to 5.1 cm², and all delayed seeking treatment by about 9 months due to their psychiatric backgrounds.
- Current treatment lacks standardization, focusing on temporary fixes like palatal obturators, while ongoing cocaine use and refusal of addiction care hinder recovery, highlighting the need for integrated approaches combining addiction support with prosthetic rehabilitation.
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