Colletti Giacomo, Autelitano Luca, Chiapasco Matteo, Biglioli Federico, Giovanditto Federica, Mandalà Marco, Allevi Fabiana
Assistant Professor, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
Consultant, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
J Oral Maxillofac Surg. 2014 Jul;72(7):1395.e1-10. doi: 10.1016/j.joms.2014.03.013. Epub 2014 Mar 31.
This article presents a review of the literature and proposes a protocol for managing acute and chronic midfacial cocaine-induced injuries.
This report describes a series of 4 patients affected by cocaine-induced midline destructive lesions. Three patients came to the authors' attention after 18 months of drug withdrawal and underwent surgical treatments to restore nasal and palatal morphology and function, and the fourth patient was referred because of acute cocaine-induced destructive lesions and was treated by aggressive debridement. An 18-month drug-free period is planned before beginning any reconstructive procedures in this latter patient.
Long-term follow-up showed stable results without relapse of palatal fistulas and good esthetic nasal appearance in all 3 patients undergoing reconstruction. The fourth patient did not show any disease progression and will be monitored for drug withdrawal.
Chronic cocaine consumption may cause multiple types of damage to the soft and hard tissues of the midface. Acute lesions must be addressed with aggressive debridement. As a result of chronic injury, the palate and nose are deformed in a very complex way and the vascularity of the remaining local tissues may be compromised or inadequate for flap harvesting. Palatal and nasal reconstructions are very delicate operations and should be addressed separately to maximize the predictability of the result.
本文对文献进行综述，并提出一套管理急性和慢性面部中部可卡因所致损伤的方案。
本报告描述了4例受可卡因所致中线破坏性病变影响的患者。3例患者在戒毒18个月后引起作者关注，接受了手术治疗以恢复鼻和腭的形态及功能，第4例患者因急性可卡因所致破坏性病变前来就诊，接受了积极的清创治疗。计划在后者开始任何重建手术前有18个月的戒毒期。
长期随访显示，所有3例接受重建手术的患者结果稳定，腭瘘未复发，鼻外观美观。第4例患者未出现任何疾病进展，将接受戒毒监测。
长期吸食可卡因可能对面部中部的软组织和硬组织造成多种损害。急性病变必须通过积极的清创来处理。由于慢性损伤，腭和鼻会以非常复杂的方式变形，剩余局部组织的血供可能受损或不足以进行皮瓣采集。腭和鼻的重建是非常精细的手术，应分别进行以最大限度提高结果的可预测性。
