Myon L, Delforge A, Raoul G, Ferri J
Service de chirurgie maxillofaciale, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille cedex, France.
Rev Stomatol Chir Maxillofac. 2010 Feb;111(1):32-5. doi: 10.1016/j.stomax.2009.01.009. Epub 2010 Jan 12.
The easier access to cocaine allows chronic and intensive consumption. Nasally inhaled cocaine causes important midfacial lesions called: Cocaine Induced Midline Destructive Lesions. These lesions are due to several factors, the anesthetic, vasoconstrictive, locally prothrombotic properties of cocaine and its components combined with cytotoxic effects and traumatic nasal injuries related to consumption mode. Functional signs are: nasal regurgitation, rhinolalia, rhinorrhea, and midfacial pain. The morphological modifications of the nasal pyramid feature the destruction of bone and cartilage structures. Endo-buccal examination, anterior rhinoscopy, and TDM reveal palatine necrosis of variable extension. Nasal fossae superinfection is always present. Sinus superinfection is frequent. Management is multidisciplinary. Weaning must be achieved before surgery. It is necessary to rehabilitate speech and swallowing functions by the means of various local or free flaps.
可卡因更容易获取，导致了长期大量使用。经鼻吸入可卡因会引发重要的面中部病变，称为：可卡因诱发的中线破坏性病变。这些病变是由多种因素导致的，包括可卡因及其成分的麻醉、血管收缩、局部促血栓形成特性，以及与使用方式相关的细胞毒性作用和外伤性鼻损伤。功能症状包括：鼻反流、鼻音、鼻漏和面中部疼痛。鼻锥体的形态改变表现为骨和软骨结构的破坏。口腔内检查、前鼻镜检查和TDM显示腭部不同程度的坏死。鼻窝总是存在继发感染。鼻窦继发感染很常见。治疗需要多学科协作。在手术前必须实现戒毒。有必要通过各种局部或游离皮瓣来恢复言语和吞咽功能。
