Saibene Alberto Maria, Nitro Letizia, Carsuzaa Florent, Alexandru Mihaela, Bedarida Vincent, Di Bari Matteo, Fath Léa, Garcia-Lliberos Ainhoa, Legré Margaux, Lobo-Duro David, Maniaci Antonino, Radulesco Thomas, Sowerby Leigh, Tan Neil, Tucciarone Manuel, Vandersteen Clair, Favier Valentin, Fieux Maxime
Young Otolaryngologists-International Federation of Otorhinolaryngological Societies (Yo-IFOS), F-75000 Paris, France.
Otolaryngology Unit, ASST Santi Paolo E Carlo, Department of Health Sciences, Università Degli Studi Di Milano, F-20133 Milan, Italy.
J Pers Med. 2025 Jun 3;15(6):231. doi: 10.3390/jpm15060231.
Recreational nasal cocaine use (RNCU) presents a significant challenge for rhinologists due to cocaine-induced midline destructive lesions (CIMDLs). This clinical consensus statement (CCS) offers guidelines for diagnosing, assessing, and managing both proven and suspected cases of CIMDL (including those without a prior RNCU history). It aims to support clinicians in addressing these complex cases effectively. An international, multidisciplinary panel of 18 specialists employed a three-round modified Delphi-method survey to evaluate statements covering CIMDL management issues such as definition, clinical evaluation and diagnosis, initial management approaches, and surgical management of complications and reconstructions. This study primarily targets otorhinolaryngologists. Out of 44 evaluated statements, 20 achieved strong consensus, 20 reached consensus, 3 approached near-consensus, and 1 failed to achieve consensus. Consensus-covered areas included the definition of CIMDL, clinical evaluations, first-line management, and management of complications. However, reconstructive techniques remained a contentious topic. In the absence of extensive data, this CCS establishes a management framework for CIMDL, significantly bridging a knowledge gap. It highlights the need for standardized assessments, multidisciplinary cooperation, and customized follow-up care for patients with CIMDL. Considering the widespread use of cocaine, physicians should consistently consider the possibility of RNCU when encountering chronic inflammatory lesions in the sinonasal tract.
由于可卡因诱发的中线破坏性病变（CIMDL），娱乐性鼻腔使用可卡因（RNCU）给鼻科医生带来了重大挑战。本临床共识声明（CCS）为诊断、评估和管理已证实及疑似的CIMDL病例（包括那些无既往RNCU病史的病例）提供了指导方针。其目的是支持临床医生有效处理这些复杂病例。一个由18名专家组成的国际多学科小组采用三轮改良德尔菲法调查，以评估涵盖CIMDL管理问题的声明，如定义、临床评估与诊断、初始管理方法以及并发症和重建的手术管理。本研究主要针对耳鼻喉科医生。在44条评估声明中，20条达成了强烈共识，20条达成了共识，3条接近达成共识，1条未达成共识。达成共识的领域包括CIMDL的定义、临床评估、一线管理和并发症管理。然而，重建技术仍然是一个有争议的话题。在缺乏广泛数据的情况下，本CCS为CIMDL建立了一个管理框架，显著弥补了知识空白。它强调了对CIMDL患者进行标准化评估、多学科合作和定制化随访护理的必要性。考虑到可卡因的广泛使用，医生在遇到鼻窦慢性炎症性病变时应始终考虑RNCU的可能性。
