Year: 2008
Type: article
Study design: Case Report
Abstract: A 54-year-old man presented with a 23-year history of intranasal cocaine use.Over the 3 months prior to consultation, he had noticed mild hypernasal speech and velopharyngeal insufficiency evidenced by nasal regurgitation of solid and liquid oral intake.He admitted that these symptoms impaired his social life.On examination, a 6 X 6-mm perforation of the midline hard palate was present (figure) .In addition, a large septal perforation without saddle-nose deformity was noted.Head and neck complications of cocaine use are well documented.The most well-known complication is septal perforation, which occurs in approximately 5% of intranasal cocaine users.'Epistaxis, chronic rhinitis, hyposmia, palatal perforation , midface destruction, decreased mucociliary transport, and nasal infection have all been documented to occur secondary to cocaine abuse.The mechanisms by which cocaine causes its destructive effects include local ischemia secondary to vasoconstriction, inflammation caused by chemical adulterants put in "cut" cocain e, and infection secondary to trauma, decreased local immunity, and impaired mucociliary tr ansport. 2 In addition to cocaine abu se, the differential diagnosis of palatal perforations includes trauma, inhalation of other narcotics, midline lethal granuloma, Wegener granulomatosis, malignancy, and infection caused by tuberculosis, tertiary syphilis, leishmaniasis, mucormycosis, actinomycosis, diphtheria, or lepros y.' Several options exist for th e treatment of palatal perforations.For definitive surgical reconstruction, local advancement and/or rotation flaps can be used in a fashion similar to the techniques used for cleft palate repairs .Local flaps th at have been used include neigh-
Source: Ear Nose & Throat Journal
Authors: Marc Cohen, Vishad Nabili, Dinesh K. Chhetri
Institution: University of California, Los Angeles
Language: English
Subfield: Genetics
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W2469106949