a Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance , Centre Hospitalier Universitaire , Montpellier , France.
Subst Abus. 2013;34(4):409-14. doi: 10.1080/08897077.2013.781565.
The link between nasal inhalation of cocaine and nasal and palatal necrosis is well documented. In contrast, few data are available concerning nasal mucosa necrosis related to heroin snorting. The authors report here the retrospective analysis of 24 cases of orofacial lesions in patients with nasal heroin usage, collected between 2006 and 2012.
The cases concern 17 males and 7 females (median age 29.5 (range: 24-42)) with chronic consumption of intranasal heroin (from 2 months to more than 10 years). Six patients had a history of cocaine abuse. The median daily amount of heroin consumption was 5 g (range: 0.5-10). The complications were nasal perforation (11 cases), nasal ulceration or erythema (5 cases), nasal septum necrosis (5 cases), pharyngeal ulceration (3 cases), and palate damages (5 cases). The most common clinical signs and symptoms were nasal pain, purulent sputum, dysphagia, and rhinitis. Maintenance therapy with methadone (19 cases) or buprenorphine (3 cases) was initiated. In 8 cases, the injury improved.
The potential of heroin to induce destructive orofacial lesions should be considered when nasal damages are observed in patients with drug abuse. A multidisciplinary approach seems to be the most effective means of managing such patients.
可卡因经鼻腔吸入与鼻和腭坏死之间的联系已有充分的文献记载。相比之下，有关与海洛因鼻吸相关的鼻黏膜坏死的数据则很少。作者在此报告了 2006 年至 2012 年间收集的 24 例与鼻内海洛因使用相关的口腔颌面部损伤的回顾性分析。
这些病例涉及 17 名男性和 7 名女性（中位年龄 29.5 岁（范围：24-42 岁）），他们有慢性鼻腔内海洛因使用史（2 个月至 10 年以上）。6 名患者有可卡因滥用史。每日海洛因使用量中位数为 5 克（范围：0.5-10 克）。并发症包括鼻穿孔（11 例）、鼻腔溃疡或红斑（5 例）、鼻中隔坏死（5 例）、咽部溃疡（3 例）和腭部损伤（5 例）。最常见的临床症状是鼻痛、脓性痰、吞咽困难和鼻炎。开始使用美沙酮（19 例）或丁丙诺啡（3 例）维持治疗。8 例患者的损伤有所改善。
在滥用药物的患者中观察到鼻损伤时，应考虑海洛因引起破坏性口腔颌面部损伤的可能性。多学科方法似乎是管理此类患者最有效的手段。
