Giacomo Colletti1, Luca Autelitano2, Matteo Chiapasco3, Federico Biglioli4, Federica Giovanditto5, Marco Mandalà6, Fabiana Allevi7. 1. Assistant Professor, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy. Electronic address: giacomo.colletti@gmail.com. 2. Consultant, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy. 3. Professor, Department of Oral Surgery, University of Milan, San Paolo Hospital, Milan, Italy. 4. Professor, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy. 5. Resident, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy. 6. Adjunct Professor, Department of Otolaryngology, University of Verona, Verona, Italy. 7. Assistant Professor, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
Abstract
PURPOSE: This article presents a review of the literature and proposes a protocol for managing acute and chronic midfacial cocaine-induced injuries. MATERIALS AND METHODS: This report describes a series of 4 patients affected by cocaine-induced midline destructive lesions. Three patients came to the authors' attention after 18 months of drug withdrawal and underwent surgical treatments to restore nasal and palatal morphology and function, and the fourth patient was referred because of acute cocaine-induced destructive lesions and was treated by aggressive debridement. An 18-month drug-free period is planned before beginning any reconstructive procedures in this latter patient. RESULTS: Long-term follow-up showed stable results without relapse of palatal fistulas and good esthetic nasal appearance in all 3 patients undergoing reconstruction. The fourth patient did not show any disease progression and will be monitored for drug withdrawal. CONCLUSION: Chronic cocaine consumption may cause multiple types of damage to the soft and hard tissues of the midface. Acute lesions must be addressed with aggressive debridement. As a result of chronic injury, the palate and nose are deformed in a very complex way and the vascularity of the remaining local tissues may be compromised or inadequate for flap harvesting. Palatal and nasal reconstructions are very delicate operations and should be addressed separately to maximize the predictability of the result.
PURPOSE: This article presents a review of the literature and proposes a protocol for managing acute and chronic midfacial cocaine-induced injuries. MATERIALS AND METHODS: This report describes a series of 4 patients affected by cocaine-induced midline destructive lesions. Three patients came to the authors' attention after 18 months of drug withdrawal and underwent surgical treatments to restore nasal and palatal morphology and function, and the fourth patient was referred because of acute cocaine-induced destructive lesions and was treated by aggressive debridement. An 18-month drug-free period is planned before beginning any reconstructive procedures in this latter patient. RESULTS: Long-term follow-up showed stable results without relapse of palatal fistulas and good esthetic nasal appearance in all 3 patients undergoing reconstruction. The fourth patient did not show any disease progression and will be monitored for drug withdrawal. CONCLUSION: Chronic cocaine consumption may cause multiple types of damage to the soft and hard tissues of the midface. Acute lesions must be addressed with aggressive debridement. As a result of chronic injury, the palate and nose are deformed in a very complex way and the vascularity of the remaining local tissues may be compromised or inadequate for flap harvesting. Palatal and nasal reconstructions are very delicate operations and should be addressed separately to maximize the predictability of the result.
Authors: Letizia Nitro; Carlotta Pipolo; Gian Luca Fadda; Giovanni Felisati; Alberto Maria Saibene; Fabiana Allevi; Mario Borgione; Giovanni Cavallo Journal: Eur Arch Otorhinolaryngol Date: 2022-02-09 Impact factor: 3.236