Case for diagnosis. Palate perforation due to cocaine use

Blanco, Graciela Fernández; Madeo, Maria Cecilia; Martínez, Mariana; Vázquez, M E Molina

doi:10.1590/abd1806-4841.20177232

Cited by 10 publications

(25 citation statements)

References 6 publications

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“…Clinically, CIMDL may mimic aggressive neoplastic and necrotizing inflammatory disease such as WG, atrophic rhinitis, tertiary syphilis, systemic lupus erythematous, lymphoma, tuberculosis, leishmaniasis, deep fungal infections, and others. The correct diagnosis can be reached by a detailed examination of the clinical, radiological, analytical, and histopathological findings [11]. All patients suspected of CIMDL should be evaluated following a diagnostic protocol including: This protocol allowed a relatively quick and conclusive diagnosis in all patients, even if the adequate medical history is often necessary for the exact diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…These CIMDL display a clinical pattern, mimicking aggressive neoplastic and necrotizing inflammatory diseases with positive ANCA tests, radiographic abnormalities, chiefly in the nasal septum and turbinates, or marked histopathological changes, such as Wegener's granulomatosis (WG), atrophic rhinitis, tertiary syphilis, systemic lupus erythematous, lymphoma, tuberculosis, leishmaniasis and fungal infections (aspergillosis, mucormycosis, blastomycosis) [7,[10][11][12]. ANCA are detectable in most patients with WG as well as in most patients with CIMDL.…”

Section: Introductionmentioning

confidence: 99%

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Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis

Cosola

Ambrosino

Limongelli

et al. 2021

IJERPH

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The prolonged use of intranasal cocaine can destroy the nasal architecture with the erosion of the palate, turbinates, and ethmoid sinuses causing cocaine-induced midline lesions (CIMDL). The CIMDL display a clinical pattern mimicking variable diseases. The aim of this study was to highlight the difficulties in reaching a correct diagnosis through the evaluation of eight new cases. The diagnostic procedures followed in these patients included: detailed medical history, clinical and histological examination, computed tomography and magnetic resonance imaging, laboratory findings (complete blood count, sedimentation rate, antinuclear antibody test, rheumatoid factor, venereal disease research laboratory test, leishmaniasis and fungal serology, antineutrophil cytoplasmic antibodies ANCA test), and chest X-ray. All patients complained of epistaxis, halitosis, nasal scabs and obstruction, decreased sense of smell and/or taste, oro-nasal regurgitation of solids and liquids with recurrent sinus infections, and chronic facial pain. On clinical examination, all patients showed palate perforation with variable nasal structure involvement and presented a strong positivity for ANCA tests with a p-ANCA pattern. The followed protocol for the CIMDL diagnosis allowed for a relatively quick and conclusive diagnosis in all patients. A multidisciplinary approach is mandatory in the management of CIMDL, involving dental professionals, maxillofacial surgeons, and psychologists.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis

Cosola

Ambrosino

Limongelli

et al. 2021

IJERPH

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“…Esto ayuda a diferenciarlo de la granulomatosis con poliangitis (Wegener), que presenta también ANCA positivo, pero con patrón citoplasmático (c-ANCA) y especificidad hacia la proteinasa 3 (PR3) 2,5 . Otro hallazgo clínico para diferenciar estas dos entidades es el paladar perforado, el cual se presenta con mayor frecuencia en los cuadros asociados al abuso de cocaína que a la granulomatosis con poliangitis (Wegener) 6,7 .…”

Section: Comentariosunclassified

Úlcera mediofacial secundaria al consumo de cocaína

Buffetti¹,

Radonich²,

Reichardt³

et al. 2020

Dermatol. Argent.

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Hay una creciente incidencia de lesiones cutáneas secundarias al consumo de cocaína, con un espectro clínico variado. Esos cuadros tienen un origen multifactorial: el efecto vasoconstrictor de la cocaína, el levamisol que potencia el efecto serotoninérgico y dopaminérgico de esta y el efecto traumático de los cristales al ser inhalado. Aún no se ha logrado consenso para el manejo de esta patología. Se presenta el caso de un paciente varón de 50 años con una úlcera en la mucosa nasal y los tejidos adyacentes, secundaria al consumo de cocaína, que tuvo buena respuesta al tratamiento instaurado.

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“…Cocaine also blocks the sodium channels and thus interferes with nerve transmission leading to an anesthetic effect. In the 19th century, Köller reported its use as an anesthetic agent in his ophthalmologic medical practice and for decades it has been very popular in ENT nose surgery as an excellent topical anesthetic ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Destruction progresses centrifugally into the nose lateral wall, sinuses and hard or soft palate leading to oronasal or oroantral communication. These local ischemic and traumatic complications are included in the so-called cocaine-induced midline destructive lesion (CIMDL) and is based in the clinical or radiological detection of at least 2 of these signs: (a) septum perforation, (b) lateral nasal wall destruction of the inferior or middle turbinate in the maxillary or ethmoid sinus destruction and (c) hard palate involvement ( 2 , 3 , 7 ). Another pathogenic route is the recently reported ANCA-associated vasculitis attributed to levamisole, an anti-helminthic agent with immunomodulatory properties that is used as a common cocaine adulterant (even 70% of its composition) as it potentiates its stimulant effects ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of cocaine-induced palatal perforations: Report of three cases and literature review

2021

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Destruction of the osteocartilaginous framework of the nose and sinuses is a well-known side effect of inhaled cocaine. Palate involvement is, however, a very uncommon event that may lead to oronasal communication with the subsequent food and liquids reflux and nasal speech. Given the addictive character of this etiologic agent, the management of cocaine-induced palatal perforations tends to be conservative by means of a prosthetic obturator. In this paper three cases with surgically treated cocaine-induced palatal perforations are reported and a review of the literature is made focusing on the management of this process. Despite the usual reluctancy, surgical palatal reconstruction should be considered in selected committed patients as a definitive solution for the annoying rhinolalia and solid-liquid reflux to the nose, thus improving their quality of life and social relationships. Key words: Cocaine, oral fistula, palate, palatal perforation, oronasal communication.

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Case for diagnosis. Palate perforation due to cocaine use

Cited by 10 publications

References 6 publications

Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis

Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis

Úlcera mediofacial secundaria al consumo de cocaína

Surgical treatment of cocaine-induced palatal perforations: Report of three cases and literature review

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