Cocaine-induced oronasal communication of the midline of the palate: A case report.

Abstract

Cocaine abuse poses a significant public health challenge, leading to severe systemic and localized complications. Intranasal cocaine use can result in chronic rhinitis, septal perforation, and palatal perforation due to its vasoconstrictive effects, which cause ischemia and tissue necrosis. We present the case of a 44- year-old woman with a 10-month history of palatal perforation, attributed to 12 years of chronic cocaine use, presented with nasal regurgitation, feeding difficulties, and cachexia. Examination revealed a 3 x 2 cm palatal perforation, nasal asymmetry, and a saddle nose deformity. Computerized tomography scans showed extensive nasal septum perforation and sinus mucosal thickening. Initial treatment involved antibiotics for sinusitis, followed by the fabrication of an obturator prosthesis to improve speech and feeding. The chronicity and extent of the palatal and nasal damage illustrates the severe consequences that can arise from sustained abuse. This case highlights not only the physical manifestations but also the challenges in managing such cases, emphasizing the necessity of a multidisciplinary approach. The integration of dental, otolaryngological, and psychological care is crucial for both immediate and long-term management. The main lesson from this case is the importance of comprehensive, patient-centered care that prioritizes stabilization and quality of life while supporting the patient's path to rehabilitation. Provisional treatment with an obturator prosthesis can provide significant improvement in speech and feeding, providing a viable solution until the patient can maintain abstinence. Conservative management and prosthetic rehabilitation remain effective options, reinforcing the need for individualized, multidisciplinary care strategies.