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Snorting cocaine effect on hard palate erosion and perforation!

This man at his twenties presented to the surgical clinic with a hole in the roof of his mouth (palate) that allowed nasal regurgitation of food when he ate. The hole had been present for a year, and he requested surgical correction. The patient reported a 5-year history of nasal cocaine use from which he had recently abstained. Physical examination revealed a large perforation of the nasal septum and midline palate with and collapse of the nasal dorsum. Local complications of intranasal cocaine abuse include chronic rhinitis, sinusitis, epistaxis, ossification or necrosis of the nasal septum, and in rare cases, palatal perforation. The hole developed as a result of the use of cocaine, a potent vasoconstrictor (results in narrowing of blood vessels). The vasoconstrictive and caustic effect of the drug can produce direct irritation and ischemia of the nasal and palatine mucosa, leading over the long term to the creation of an oronasal perforation secondary to maxillary bone destruction. The destroyed anatomy was reconstructed by using standard surgical techniques.