[Local complications of intranasal cocaine abuse: diagnostic and therapeutic guidelines]

In addition to causing nasal septum perforation, cocaine abuse can cause extensive destruction of the osteocartilaginous structures of the nose. The clinical picture can mimic other diseases, such as vasculitis and lymphoma. Here we describe 3 patients with nasal deformities. One patient, a 39-year-old woman, had a large cocaine-related septum perforation, which caused a saddle-nose deformity. This deformity was corrected via external-approach rhinoplasty. The second patient, a 58-year-old man with limited granulomatosis with polyangiitis, presented with recurrent nose bleeds. He was treated with prednisolone for an exacerbation of symptoms. His nasal defects are now stable. The third patient, a 41-year-old man, had extensive deformities and tissue defects of the nose and palate. He was treated surgically, but this was followed by a relapse of the tissue defects due to persistent cocaine abuse. In patients with destruction of the nasal skeleton, the possibility of cocaine abuse should always be considered.