Aggressive destructive midfacial lesion from cocaine abuse

doi:10.1067/moe.2002.126020

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 94, Issue 4, October 2002, Pages 465-470

Presented at the 55th Annual Meeting of the American Academy of Oral and Maxillofacial Pathology, Chicago, Ill, April 27-May 2, 2001.

https://doi.org/10.1067/moe.2002.126020 Get rights and content

Abstract

Since the first reported case in 1912 of cocaine-induced perforation of the palate, an additional 7 cases have been reported describing extensive palatal destruction. The clinical presentation shares similarities with nasal-type natural killer/T-cell lymphoma, Wegener's granulomatosis, and infectious diseases. We describe a 50-year-old woman with a progressively destructive midfacial process that initially appeared as a small, localized palatal defect. Over time, the lesion caused bilateral deformity of the ala, extensive loss of the palate, maxillary and sinonasal complexes, ethmoids, and ulceration of adjacent tissue. Clinical laboratory tests showed elevated cytoplasmic-antineutrophil cytoplasmic antibodies, but the histopathology did not support the diagnosis of Wegener's granulomatosis. Special stains and cultures were negative for infectious organisms. Flow cytometry and T-cell gene rearrangement studies ruled out lymphoma. Because of the inability to diagnose this worrisome process, the presence of polarizable foreign material in the original biopsy, and the patient's admission to past cocaine use, a urine drug screen was performed, which was positive for cocaine and marijuana. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:465-70)

Section snippets

Case report

A 50-year-old woman came to the Emory University Otolaryngology-Head and Neck Surgery Clinic with nasal speech and an ill-fitting prosthetic palatal obturator, which covered a defect in the palate. The patient had originally noticed the problem 2 years previously when coffee she drank came out of her nose. Otherwise, the patient was in good overall health and reported no alcohol or tobacco use. However, her history was significant for cocaine use years ago, which she claimed to have stopped.

Discussion

Our patient represents the eighth reported case in the English-language literature of palatal perforation from intranasal cocaine abuse. All previously described patients had clinical signs and symptoms comparable to this case. Furthermore, the palatal lesions showed nearly identical gross and microscopic features. However, for reasons not yet identified, 3 of the previously reported patients had elevated serum levels of c-ANCA. A summary of the clinical, laboratory, and histologic findings in

Conclusion

Intranasal cocaine abuse may cause significant local ischemic necrosis and destruction of the sinonasal and midfacial bones and soft tissue to the extent of mimicking aggressive neoplastic and necrotizing inflammatory diseases. Clinical distinction from angiocentric nasal NK/T-cell lymphoma and Wegener's granulomatosis may be difficult. Here we present a case of cocaine-induced midfacial destruction in which the laboratory finding of elevated c-ANCA further complicated diagnosis, creating a

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There are more references available in the full text version of this article.

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^*: Reprint requests: Susan Müller, DMD, Emory University Hospital, Department of Pathology, 1364 Clifton Road NE, Atlanta, GA 30322

^**: ^aResident Oral and Maxillofacial Pathology, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Ga.

^*: ^bAssociate Professor, Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Ga.

^**: ^cAssistant Professor, Departments of Pathology and Laboratory Medicine, and Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Ga.

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Oral and Maxillofacial PathologyAggressive destructive midfacial lesion from cocaine abuse*,**,*,**

Abstract

Section snippets

Case report

Discussion

Conclusion

Otolaryngol Head Neck Surg

Rheum Dis Clin North Am

Progressive septal and palatal perforation secondary to intranasal cocaine abuse

Med J Malaysia

Osteocartilaginous necrosis of the sinonasal tract following cocaine abuse

Laryngoscope

Perforation of the hard palate associated with cocaine abuse

Ann Plastic Surg

Nasal cocaine abuse presenting as central facial destructive granuloma

Eur Arch Otorhinolaryngol

Oral and Maxillofacial Pathology
Aggressive destructive midfacial lesion from cocaine abuse*,**,*,**