"A healthy mouth, makes a pleasant and functional
social message positive and reassuring."

dc. Maurizio Serafini



Authors: INCHINGOLO Francesco1-2, BULZACCHELLI NICOLA1, MARRELLI Massimo2, TATULLO Marco1-2, INCHINGOLO Angelo Michele3, SERAFINI Maurizio4, PUGLIESE Adalisa1, INCHINGOLO Alessio Danilo1-4, SCHINCO Fabio1-4, PIGNATARO Chiara1-4, MARINELLI Grazia1, COLELLA Alessandro1, DIPALMA Gianna1-2.
1 University of Bari. Interdisciplinary Department of Medicine.
2 Calabrodental casa di cura e Tecnologica reaserch. Crotone
3 University of Milano Bicocca.
4 Freelance professional.

AIM: Cocaine is an alkaloid stimulating the nervous system, obtained from the leaves of the South American coca plant (Erythroxylum coca). Using cocaine involves clinical and social issues but above all it may damage the organs of the upper airways and cause devastating esthetical and functional injuries with destruction and corrosion of the facial structure.
The use of cocaine causes several lesions according to the way it is administered: inhalation alters the mucosa causing vasoconstriction and, with the passing of time, it causes ulcerations and perforations to the mucosa of the hard palate and to the nasal septum of the palatine bone. The patient is anesthetized because of the cocaine’s crystals; one hour after intake, apoptosis is active and the healing process is blocked. At the same time, the cocaine effect disappears and the patients wants to take a new dose; in this way, the micro-necrosis becomes macro-necrosis with a consequent perforation.
The aim of this study is to report three cases of cocaine-induced palatal perforation: the patients were aged between 27 and 39 years and presented with a long history of cocaine use.

METHODS: The first two patients presented with common symptoms: they complained food and drinks coming up from the stomach into the esophagus during the meals; nasal voice to phonation; severe hemorrhages and palatal perforation with exposure of the palatal bone; malodorous crusts and frequent infections associated to rhinitis and sinusitis.
The third patient presented with mobility of tooth 2.6 with an erosive area of the oral mucosa and bone absorption in the same area after transbuccal cocaine administration.
Instrumental examinations like CT scan allowed to identify the bone erosion while NMR allowed for a better evaluation of the soft tissue involvement.
First, the infection was treated in order to encourage the removal of crusts and lubricate the nasal mucosa. Due to the poor patient awareness, in two patients a valve was placed to avoid the passage of food into the upper airways while eating; the aim was to schedule a reconstructive surgery at least one year after interruption of cocaine consumption.
The compromised mobile element was extracted in the third patient, who also received surgical curettage of necrotic bone.

RISULTS: In the treated cases, the initial symptoms have improved, phonation in particular; it is necessary to establish a follow-up program of at least two months in order to examine the interruption of cocaine consumption and the evolution of the healing process and finally establish if it is recommended to proceed with reconstructive surgery.

CONCLUSION: Cocaine use, as well as the use of any psychotropic drug, is a problem of social importance: the main aim in this case is to treat these patients with minimally invasive techniques, because of their poorly cooperating lifestyle.