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Patient with a 1 cm perforation in the anterior hard palate (a) that can be appreciated (mark) in a coronal CT scan (b). Complete bone loss in the left palatal side in an axial view (c). For this reason the inverted flaps for the nasal lining were partial thickness and the left rotational flap was harvested from the alveolar palatal wall, where underlying bone was present. Postoperative view (6 months) (d) after performing a double opposite pediculated palatal flap.
Source publication
Destruction of the osteocartilaginous framework of the nose and sinuses is a well-known side effect of inhaled cocaine. Palate involvement is, however, a very uncommon event that may lead to oronasal communication with the subsequent food and liquids reflux and nasal speech. Given the addictive character of this etiologic agent, the management of c...
Context in source publication
Context 1
... due to food reflux to the nose. He enrolled a drug dishabituation program and wore an obturator to seal the defect during that time. At the physical examination point no signs of inflammation or suppuration were found. CT scan revealed septum destruction and a complete lack of bone at the left hard palate, where the communication was located (Fig. 2). Two layers reconstruction was performed using two opposite rotational palatal flaps for the oral side and inverted local flaps for the nasal lining. Care was taken to obtain the left flap from the dentoalveolar area, where underlying bone was present. 6 months later the palatal perforation remains sealed (Fig. 3) and the patient ...
Citations
... Oronasal fistulas (ONFs) are very common following the failure of cleft palate repair with an incidence reported up to 68% [2,3]. ONFs may also occur during iatrogenic maxillectomies for tumor excision [4], surgical removal of ectopic teeth [5], postoperative infections [6], subperiosteal dental implantation [7], orthognathic surgeries [8], septoplasty [9], segmental Le Fort I osteotomy [10], carbonion radiotherapy [11], may be attributed to chronic cocaine abuse [12] and finally, in some cases of medication-related osteonecrosis of the maxillary bone [13]. ...
Introduction:
Horseshoe Le Fort I osteotomy (HLFO) in combination with iliac bone grafts interposition is an established and very effective procedure for reconstructing the severely atrophic maxilla. However potential complications connected to this method, such as oronasal fistula (ONF), have not been described in the literature to date.
Case presentation:
We report the case of a female patient with severe atrophy of the edentulous maxillary alveolar ridge with type 2 diabetes (T2D). Initially, a sinus floor augmentation was performed, followed by a failed placement of dental implants. Afterwards, HLFO with simultaneous interposition of iliac bone grafts was conducted. Subsequently, an oronasal communication occurred in the antral maxilla. As several local flaps had not achieved sufficient results, a melolabial interpolated island flap was carried out, yielding satisfactory results.
Discussion:
Failed implant treatment or bone augmentation procedures in combination with T2D may have resulted in significant tissue irritation and subsequent wound healing complications in the antral maxilla, leading to an ONF.
Conclusion:
In this case, an ONF occurring after HLFO was described for the first time. The melolabial interpolated island flap proved to be an outstanding long-term solution for the management of an anterior ONF occurring after HLFO over a period of 10 years. Less invasive treatment options including zygomatic implants should be taken into consideration for the treatment of such patients.
... CIMDL are often overlooked in clinical practise, particularly if a history of cocaine inhalation is not sought or volunteered. Although several reconstructive procedures or maxillary obturator prosthesis have been proposed to repair palatal defects, the best therapeutic choice is still a matter of discussion [10,[14][15][16][17][18][19][20]. ...
The prolonged use of intranasal cocaine can destroy the nasal architecture with the erosion of the palate, turbinates, and ethmoid sinuses causing cocaine-induced midline lesions (CIMDL). The CIMDL display a clinical pattern mimicking variable diseases. The aim of this study was to highlight the difficulties in reaching a correct diagnosis through the evaluation of eight new cases. The diagnostic procedures followed in these patients included: detailed medical history, clinical and histological examination, computed tomography and magnetic resonance imaging, laboratory findings (complete blood count, sedimentation rate, antinuclear antibody test, rheumatoid factor, venereal disease research laboratory test, leishmaniasis and fungal serology, antineutrophil cytoplasmic antibodies ANCA test), and chest X-ray. All patients complained of epistaxis, halitosis, nasal scabs and obstruction, decreased sense of smell and/or taste, oro-nasal regurgitation of solids and liquids with recurrent sinus infections, and chronic facial pain. On clinical examination, all patients showed palate perforation with variable nasal structure involvement and presented a strong positivity for ANCA tests with a p-ANCA pattern. The followed protocol for the CIMDL diagnosis allowed for a relatively quick and conclusive diagnosis in all patients. A multidisciplinary approach is mandatory in the management of CIMDL, involving dental professionals, maxillofacial surgeons, and psychologists.
Exposure to certain harmful agents through inhalation, chronic skin exposure, or intravenous use may lead to chemical toxicity with granulomatous inflammatory reaction. The common forms of such toxicity include Cocaine abuse, Berryliosis seen in industrial workers, Talcosis (Silicosis) due to talcum powder use, and Tattooing. Cocaine snorting is associated with a peculiar type of drug-induced chronic rhinitis, which leads to inflammation of the sinonasal mucosa, slowly progressing to a destruction of nasal, palatal and pharyngeal tissues. These characteristic lesions due to cocaine abuse are commonly called cocaine-induced midline destructive lesions (CIMDL). Chronic beryllium disease (CBD) is a granulomatous lung disorder that results from beryllium exposure in a genetically susceptible host. Pulmonary talcosis, a form of pulmonary foreign body granulomatosis (PFBG), can occur in drug addicts as a result of intravenous injection of oral medications. The condition has been termed intravascular talcosis, to differentiate it from disorders arising from exposure to inhalational talc, such as simple talcosis, progressive massive fibrosis, talcosilicosis, and talcoasbestosis, often with pleural disease. Skin reactions caused by tattoo (especially red pigment) and silicon needle acupunctures vary from simple dermatitis to lichenoid, pseudolymphomatous and granulomatous reactions.
