Palatal fistula resulting from cocaine abuse: a case report

Cocaine blocks the reuptake of norepinephrine and dopamine of the sympathetic nervous system. It has a psychomotor stimulating effect that provokes euphoria, motor activity and an amplification of a well being sensation similar to the effect of amphetamines. Well known are the systemic effects of cocaine abuse (acute myocardial infarction, cardiac arrhythmias, aortic ruptures, cerebrovascular accidents). Several local effects are also documented involving above all palatal mucosa and central midface structures. The most common palatal lesions are fistulae resulting from ischemia caused by the constricting effect of cocaine on small vessels, mucosal breakdown, loss of palatal bone, and loss of nasal mucosa. IF cocaine use becomes chronic and compulsive, wider lesions may cause extensive destruction of the osteocartilagineous structures of the nose, sinus and palate, a syndrome called CIMDL (cocaine-induced midline destructive lesion). Many techniques have been described to treat these defects depending on the size and the involved structures of the face. These techniques range from local flaps to complex free flaps. The authors describe a case of a median hard and soft palatal fistula resulting from cocaine abuse treated with local bilateral palatal flaps, and analyze the most common therapeutic options described in literature.