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

Abstract

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.

Melolabial interpolated island flap for reconstruction of an anterior oronasal fistula after horseshoe Le Fort I osteotomy with iliac bone grafts interposition - A case report

“…Oronasal fistulas (ONFs) are very common following the failure of cleft palate repair with an incidence reported up to 68% [2] , [3] . ONFs may also occur during iatrogenic maxillectomies for tumor excision [4] , surgical removal of ectopic teeth [5] , postoperative infections [6] , subperiosteal dental implantation [7] , orthognathic surgeries [8] , septoplasty [9] , segmental Le Fort I osteotomy [10] , carbon-ion radiotherapy [11] , may be attributed to chronic cocaine abuse [12] and finally, in some cases of medication-related osteonecrosis of the maxillary bone [13] .…”

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

“…CIMDL are often overlooked in clinical practise, particularly if a history of cocaine inhalation is not sought or volunteered. Although several reconstructive procedures or maxillary obturator prosthesis have been proposed to repair palatal defects, the best therapeutic choice is still a matter of discussion [10,[14][15][16][17][18][19][20].…”