Cocaine-Induced Midline Destructive Lesions: A Real Challenge in Oral Rehabilitation

Andrea Rampi, Alessandro Vinciguerra, Stefano Bondi, Nicoletta Stella Policaro and Giorgio Gastaldi
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Andrea Rampi: Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
Alessandro Vinciguerra: Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
Stefano Bondi: Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
Nicoletta Stella Policaro: Dental School, Vita-Salute San Raffaele University, 20132 Milan, Italy
Giorgio Gastaldi: Dental School, Vita-Salute San Raffaele University, 20132 Milan, Italy

IJERPH, 2021, vol. 18, issue 6, 1-10

Abstract: Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.

Keywords: cocaine-induced midline destructive lesions; CIMDL; reconstructive surgery; palatal perforations; prosthetic rehabilitation; palatal obturators (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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