Diagnostic considerations and prosthetic rehabilitation of a cocaine-induced midline destructive lesion: A clinical report

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The intranasal inhalation of cocaine has numerous complications. In addition to its systemic effects, cocaine can cause extensive destruction of the osteocartilaginous midline structures of the palate, nose, and sinuses. Without an accurate social and clinical history, a cocaine-induced midline destructive lesion can cause diagnostic difficulties, because its clinical presentation closely mimics other diseases. This clinical report describes an oronasal defect caused by cocaine use, the diagnostic considerations of these lesions, and prosthetic management of the defect.

Section snippets

Clinical report

A 48-year-old man was referred to a cancer center complaining of the inability to eat and speak properly because of an ill-fitting obturator. The patient had a history of intranasal cocaine abuse with erosion of the hard and soft palate. He had discontinued use of an obturator due to poor prosthesis retention from his grossly carious dentition. His social history included intranasal inhalation of cocaine multiple times daily for a number of consecutive months. He presented with erosion of his

Summary

Accurate diagnosis of a necrotic midfacial lesion can be challenging, as the differential diagnosis includes numerous conditions that can present with similar signs and symptoms. Diagnosis requires clinical tests as well as an accurate social history. The patient presented in this clinical report had a differential diagnosis which included CIMDL, WG, and nasal lymphoma. Despite the positive history of cocaine use, the diagnosis was not certain. Biopsies were required to rule out lymphoma and

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    The mean age of the individuals who participated in the studies ranged from 13 to a maximum of 70 years. Regarding the type of study, of the 22 analyzed ones, 13 were case reports,20–23,28–34,36,38,39 five were cross-sectional studies,15,19,26,35,37 one was an experimental study,24 two were observational studies,26,35 and one was a field study.25 Although literature reviews constituted an exclusion criterion, two studies20,31 were included because they had more than one methodological type, being two case reports that contained literature reviews in their methodology.

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    At the very least, patients must confirm that they are no longer abusing the drug, and the lesion should be relatively stable. The surgical procedures that are most often requested by patients are septal and palate perforation closure [28–34]. However, some patients ask for aesthetic procedures such as rhinoplasty and closure of naso-cutaneous fistula [22,35,36].

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    2012, Side Effects of Drugs Annual
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