Sinonasal Osteocartilaginous Necrosis in Cocaine Abusers: Experience in 25 Patients

Trimarchi, Matteo; Nicolai, Piero; Lombardi, Davide; Facchetti, Fabio; Morassi, Maria Laura; Maroldi, Roberto; Gregorini, Gina; Specks, Ulrich

doi:10.1177/194589240301700107

Cited by 88 publications

(89 citation statements)

References 29 publications

(3 reference statements)

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“…23,24 Magnetic resonance imaging can detect areas of abnormal nasal or paranasal mucosa. 11,25 In cocaine abusers, significant enlargement of the palatine or pharyngeal tonsils has been associated with small fluid collections within lymphatic tissue. 23 Radiographic signs of otitis media may also be detected.…”

Section: Discussionmentioning

confidence: 99%

“…18 Habitual nasal insufflation of cocaine powder often causes considerable damage to nasal mucosa; however, damage of the underlying perichondrium leading to nasal septum perforation and destruction of the osteocartilaginous scaffold of the nose, sinuses, and palate is much less common. 25 In more severe cases, the destruction extends to the middle and superior turbinates and the lateral wall of the nose. 13 In some patients, hard and soft palate perforations may be present.…”

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confidence: 99%

“…25 In more severe cases, the destruction extends to the middle and superior turbinates and the lateral wall of the nose.…”

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confidence: 99%

“…Their differentiation is important but may, at times, be very difficult. 25 The correct diagnosis of cocaine-induced midline destructive lesions (CIMDLs) ultimately depends on a patient's clinical history and documentation of drug abuse combined with the exclusion of other etiologies. 15 In the currently available literature, involvement of the craniovertebral junction or the spine in general in CIMDLs has never been reported.…”

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confidence: 99%

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

Brembilla¹,

Lanterna²,

Risso³

et al. 2015

SPI

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With the increasingly widespread illicit use of cocaine, a broad spectrum of clinical pathologies related to this form of drug abuse is emerging. The most frequently used method of administration of powdered cocaine is intranasal inhalation, or “snorting.” Consequently, adverse effects of cocaine on the nasal tract are common. Habitual nasal insufflations of cocaine can cause mucosal lesions. If cocaine use becomes chronic and compulsive, progressive damage of the mucosa and perichondrium leads to ischemic necrosis of the septal cartilage and perforation of the nasal septum. Occasionally, cocaine-induced lesions cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate and can mimic other diseases such as tumors, infections, and immunological diseases. In the literature currently available, involvement of the craniovertebral junction in the cocaine-induced midline destructive lesions (CIMDLs) has never been reported. The present case concerns a 44-year-old man who presented with long-standing symptoms including nasal obstruction, epistaxis, dysphagia, nasal reflux, and severe neck pain. A diagnosis of CIMDL was made in light of the patient’s history and the findings on physical and endoscopic examinations, imaging studies, and laboratory testing. Involvement of the craniovertebral junction in the destructive process was evident. For neurosurgical treatment, the authors considered the high grade of atlantoaxial instability, the poorly understood cocaine-induced lesions of the spine and their potential evolution overtime, as well as cocaine abusers’ poor compliance. The patient underwent posterior craniovertebral fixation. Understanding, classifying, and treating cocaine-induced lesions involving the craniovertebral junction are a challenge.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…25 In more severe cases, the destruction extends to the middle and superior turbinates and the lateral wall of the nose.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Brembilla¹,

Lanterna²,

Risso³

et al. 2015

SPI

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“…Cocaine abuse may lead to chronic rhinosinusitis; it can result in soft tissue and bone destruction, due to ischemia secondary to vasoconstriction, chemical irritation, trauma, changes in mucociliary mechanism, secondary infections, and local decrease in humoral and cellular immunity 7,8 . Cocaine users are predisposed to bacterial and fungal infections, such as aspergillosis.…”

Section: Introductionmentioning

confidence: 99%

Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction

Azulay‐Abulafia

Sousa

Pussanti

et al. 2014

Rev. Soc. Bras. Med. Trop.

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Chronic invasive fungal sinusitis associated with intranasal drug use

et al. 2015

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Chronic invasive fungal sinusitis (CIFS) is a rare but potentially aggressive form of invasive fungal disease that occurs in immunocompetent patients. We report a case of CIFS in an otherwise healthy young adult associated with intranasal illicit drug abuse. The patient presented with non-healing nasal septal and palatal perforations. Biopsy demonstrated invasive Aspergillus flavus requiring surgical debridement and extended intravenous antifungal therapy. Tissue necrosis and ulceration related to intranasal drug use should be recognized as a potential risk factor for invasive fungal sinusitis.

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Sinonasal Osteocartilaginous Necrosis in Cocaine Abusers: Experience in 25 Patients

Cited by 88 publications

References 29 publications

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

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

Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction

Chronic invasive fungal sinusitis associated with intranasal drug use

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