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Purpose: Review of the literature concerning cocaine induced midline destructive lesions (CIMDL). Methods: We reviewed the English literature regarding CIMDL involving the nose and its surrounding structures. The review is based on a search of the US National Library of Medicine (PubMed) online database from January 1st, 1982 to March 31st, 2013. Results: CIMDL is a pathology that mimics systemic diseases with positive anti-neutrophil cytoplasmic antibodies (ANCA). The prevalence of CIMDL is considered to be about 4.8% among cocaine users. Clinical manifestations include hyposmia, facial pain, crusting, ulcers, nasal septal perforation, palatal perforation, sinus wall destruction, orbital erosion and damage of the anterior skull base. The presence of ANCA directed against human neutrophil elastase (HNE) is the most distinguishing feature of CIMDL. Toxicological tests, indirect immunofluorescence microscopy, antigen specific solid assay testing, histopathological analysis, apoptosis assay and MRI imaging concur in the clinical identification of CIMDL. The pathogenesis of CIMDL is poorly understood and implicates inflammatory, infective, proapoptotic and autoimmune mechanisms. Conclusion: CIMDL must be readily recognized by clinicians to provide appropriate treatment. Immunosuppressive therapy has no role in the treatment of CIMDL. Only abstinence can interrupt the progression of the disease.

This report describes the case of a patient who underwent osseointegrated dental implant placement. The implants were misplaced inside the nasal fossae and in the right maxillary sinus, causing chronic purulent sinusitis. CT scan without contrast showed signs of right maxillary sinusitis and confirmed the misplacement of four dental implants that surfaced into the nasal cavities. The imaging also revealed the presence of another implant that emerged inside the maxillary sinus. The patient underwent functional endoscopic sinus surgery with complete symptom remission at the long-term follow-up. We propose that sinusitis caused by protrusion of implants and by sinus floor lift procedures could share common physiopathological patterns and predisposing factors.

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BackgroundThe technique for transnasal endoscopic resection of inverted papilloma (IP) has evolved considerably during the last 20 years. The aim of the present study is to retrospectively analyze a single tertiary center series, with special emphasis on assessing the value of an “insertion‐driven” technique on local control.MethodsPatients undergoing endoscopic resection for IP at the University of Brescia during the period 1991 to 2015 were enrolled. Site of origin and extension of IPs were assessed, together with presence of dysplasia and carcinoma in situ. Patients were divided in 3 cohorts: (1) historical cohort (treated before 2008), (2) contemporary “centripetal” cohort (treated with a traditional technique after 2008), and (3) contemporary “insertion‐driven” cohort (treated with insertion‐driven resection). Groups were compared considering outcomes and complications.ResultsThe series included 210 patients. Mean follow‐up was 77.8 months. Thirty‐eight (18.1%) patients showed precancerous changes. Maxillary involvement (p = 0.021) and presence of precancerous changes (p = 0.013) were significantly associated with a higher risk of recurrence. Five‐year local control rate before and after 2008 was 95.1% and 90.5%, respectively. The insertion‐driven cohort was associated with lower disease control when IPs involved the maxillary sinus. The rate of complications was 11.9%. The insertion‐driven cohort was associated with a lower rate of major complications (p = 0.098).ConclusionPreoperative evidence of precancerous changes and/or involvement of maxillary sinus should prompt the surgeon to address the disease more aggressively (centripetal resection). Preoperative imaging and biopsy with abundant material may optimize the chance to stratify patients eligible for less or more conservative approaches.