Jewers Wendi M, Rawal Yeshwant B, Allen Carl M, Kalmar John R, Fox Eric, Chacon Guillermo E, Sedghizadeh Parish P
Department of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, 305 West 12th Avenue, Columbus, OH 43210, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 May;99(5):594-7. doi: 10.1016/j.tripleo.2004.04.006.
Palatal perforation resulting from insufflation of cocaine has been well documented. In comparison, reports of destructive orofacial lesions resulting from intranasal abuse of prescription narcotics are rare. We present the clinical and histologic findings in a case of palatal perforation arising in a patient abusing a prescription opioid drug. The patient denied any history of cocaine use but admitted to habitually crushing and snorting a hydrocodone/acetaminophen preparation. Study design The patient presented to our clinic seeking resolution of speech difficulties associated with an oroantral fistula. Surgical repair of the defect had been attempted unsuccessfully in the past. In addition to blood and chemistry panels, endoscopic examination was conducted, with removal of several biopsy specimens for histologic evaluation and flow cytometry. Biopsy specimens included both lesional and perilesional tissue from within the oral and nasopharyngeal cavities. Culture and cytology for fungal organisms were also performed.
Histopathologic examination revealed normal mucosa with diffuse and focal inflammatory changes and no evidence of malignancy. Polarizable foreign material was noted in the specimens. The absence of lymphoid neoplasia was confirmed by flow cytometric analysis. The toxicology panel was positive for the presence of opiates in the blood. Culture and cytology were positive for candidal organisms. A palatal obturator was fabricated for the patient, producing significant improvement in the quality of speech.
This may represent a case of palatal perforation resulting from abuse of a drug other than cocaine. The potential for drugs other than cocaine to produce destructive orofacial lesions should be considered.
可卡因吹入导致腭部穿孔已有充分记录。相比之下，因鼻内滥用处方麻醉药品导致口腔面部破坏性病变的报道却很少。我们报告了一例因滥用处方类阿片药物导致腭部穿孔患者的临床和组织学检查结果。该患者否认有任何可卡因使用史，但承认习惯性碾碎并吸食氢可酮/对乙酰氨基酚制剂。研究设计 该患者到我们诊所就诊，寻求解决与口鼻瘘相关的言语困难问题。过去曾尝试对该缺损进行手术修复，但未成功。除了血液和生化检查外，还进行了内镜检查，并取了多个活检标本进行组织学评估和流式细胞术检查。活检标本包括口腔和鼻咽腔内的病变组织及病变周围组织。还进行了真菌培养和细胞学检查。
组织病理学检查显示黏膜正常，有弥漫性和局灶性炎症改变，无恶性证据。标本中发现有可极化的异物。流式细胞术分析证实无淋巴瘤形成。毒理学检查显示血液中存在阿片类药物阳性。培养和细胞学检查显示念珠菌阳性。为患者制作了腭部阻塞器，言语质量有了显著改善。
这可能是一例由可卡因以外的药物滥用导致的腭部穿孔病例。应考虑除可卡因以外的其他药物导致口腔面部破坏性病变的可能性。
