title: Osteolytic sinusitis and pneumomediastinum: deceptive otolaryngologic complications of cocaine abuse.
abstract: Recreational cocaine abuse via intranasal "snorting," "free-base" smoking, "body-packing," or intravenous injection can be lethal. Increasing illicit use of cocaine hydrochloride and the misuse of legal over-the-counter (OTC) nasal drugs are known causative agents of nasal septal perforation with loss of taste and smell. Although 2 to 3 mg/kg is the recommended maximum dose for topical anesthesia, cocaine snorters may use 1,000 mg or more daily on a "run." Furthermore, the newer route of smoking the extracted volatile "free-base" form of the adulterated street drug provides a plasma concentration producing the same physiological and subjective effects of intravenous cocaine. Presented are two cases exemplifying unusual complications of cocaine abuse: 1. total nasal septal bony and cartilaginous necrosis with resultant saddle-nose deformity and osteolytic sinusitis secondary to chronic intranasal "snorting" and 2. tracheobronchial rupture with pneumomediastinum secondary to smoking "free-base" cocaine.
mesh_terms: D000328:Adult; D001862:Bone Resorption / Q000139:chemically induced*; D002908:Chronic Disease; D003042:Cocaine / Q000008:administration & dosage; D005005:Ethmoid Sinus / Q000187:drug effects / Q000473:pathology; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000008:administration & dosage; D008297:Male; D008443:Maxillary Sinus / Q000187:drug effects / Q000473:pathology; D008478:Mediastinal Emphysema / Q000139:chemically induced* / Q000473:pathology; D009300:Nasal Septum / Q000187:drug effects / Q000473:pathology; D009336:Necrosis; D009667:Nose Deformities, Acquired / Q000139:chemically induced / Q000473:pathology; D010014:Osteolysis / Q000139:chemically induced* / Q000473:pathology; D012852:Sinusitis / Q000139:chemically induced* / Q000473:pathology; D019966:Substance-Related Disorders / Q000150:complications* / Q000473:pathology
chemical_list: D013287:Illicit Drugs; D003042:Cocaine