Berberi Antoine, Azar Elie
Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon.
Department of ENT, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
Case Rep Otolaryngol. 2024 Jun 19;2024:7109261. doi: 10.1155/2024/7109261. eCollection 2024.
Cocaine is the second most consumed drug worldwide, more than 0.4% of the global population, and has become a real public health problem in recent years. Its inhalation causes significant centrofacial lesions, grouped under the name cocaine-induced midline destructive lesion (CIMDL). These destructions are due to the conjunction of the vasoconstrictor, local prothrombogenic effects, and cytotoxic effects of cocaine. The ischemia produced by this substance is due to vasoconstriction that leads to nasal tissue necrosis and perforation of the nasal septum secondary to chondral necrosis. . A 36-year-old man, previously grappling with cocaine addiction, was hospitalized to undergo comprehensive clinical, microbiological, and radiological examinations because he was suffering from the emergence of crusts and ulceration in the nasal mucosa, accompanied by a palate perforation, a 39°C fever, and chills. Standard bacteriological culture was positive for coagulase-negative staphylococci and , while mycological culture was positive for . The CT scan images of the sinuses confirmed the presence of palatal perforation and total destruction of the nasal septum, cartilaginous portion, maxillary sinus medial wall, lower and middle turbinates, and middle meatus. Nasal endoscopy revealed an exposition of the bony wall and displayed the exposition of the occipital bone's clivus. A diagnosis of CIMDL was confirmed. Antibiotic therapy was decided based on antibiogram results by the consulting microbiologist. Debridement of necrotic tissue was done by nasal endoscopy with local cleaning and was repetitive during the first week to maintain the best cleanliness possible. The patient was discharged with oro-nasal hygiene instructions and referred for prosthetic rehabilation. As for the cocaine addiction, the patient was in follow-up with a psychologist in a specialized centre.
The care is multidisciplinary. Psychological help and assistance are essential to guide patients to become cocaine free and to avoid a relapse. Weaning is a prerequisite for surgery. Rehabilitation of speech and swallowing is necessary. Many local flaps or micro-anastomoses are possible.
可卡因是全球第二大消费毒品，全球超过0.4%的人口吸食，近年来已成为一个严重的公共卫生问题。吸入可卡因会导致严重的面部中央病变，统称为可卡因诱发的中线破坏性病变（CIMDL）。这些破坏是由于可卡因的血管收缩、局部促血栓形成作用和细胞毒性作用共同导致的。该物质产生的缺血是由于血管收缩导致鼻组织坏死以及继发于软骨坏死的鼻中隔穿孔。一名36岁曾有可卡因成瘾问题的男子因鼻黏膜出现结痂和溃疡，并伴有腭穿孔、39°C发热和寒战而住院接受全面的临床、微生物学和放射学检查。标准细菌培养凝固酶阴性葡萄球菌呈阳性，而真菌培养[此处原文缺失真菌培养阳性结果的具体内容]呈阳性。鼻窦CT扫描图像证实存在腭穿孔以及鼻中隔软骨部分、上颌窦内侧壁、下鼻甲和中鼻甲及中鼻道的完全破坏。鼻内镜检查显示骨壁暴露，并显示枕骨斜坡暴露。确诊为CIMDL。根据咨询微生物学家的药敏试验结果决定抗生素治疗。通过鼻内镜进行坏死组织清创并局部清洁，在第一周内反复进行以保持尽可能好的清洁度。患者出院时接受了口鼻卫生指导，并被转介进行修复康复治疗。至于可卡因成瘾问题，该患者在一家专业中心接受心理学家的随访。
治疗是多学科的。心理帮助和支持对于引导患者戒除可卡因并避免复发至关重要。戒除是手术的先决条件。言语和吞咽功能的康复是必要的。有多种局部皮瓣或显微吻合术可供选择。
