Palatal prosthetic rehabilitation in patients affected by cocaine-induced midline destructive lesions

Cocaine is one of the most popular illicit drugs in Europe and cocaine-induced midline destructive lesions (CIMDL) represent a rare but destructive consequence of its intranasal use. The extent of lesions can vary remarkably and may include palate perforations with consequent oronasal reflux and hypernasal speech. The therapeutic options encompass surgery, with local and distant flaps, and prosthetic rehabilitation with palatal obturators. We retrospectively reviewed a case series of 6 patients affected by palatal perforation as part of CIMDL, who were treated with a dental or implant-retained palatal obturator at San Raffaele Dentistry Department between 2015 and 2020. In addition, we reviewed the available literature on CIMDL and the prosthetic rehabilitation of palatal perforations in this context. The most frequent symptoms reported were hypernasal speech, oro-nasal reflux, halitosis, and difficulty in interpersonal relationships. Palatal obturators were always successful in the relief of the majority of symptoms, but the duration of the benefit was strongly related to progression of the lesion, and in some cases a close follow-up and continuous modifications of the prosthesis were necessary. In conclusion prosthetic approach is a valid option for the symptomatic relief in CIMDL-related palate perforation. Nevertheless, the short-lasting efficacy for patients with active disease can be the reason for unsatisfactory results.