title: Necrosis of the intranasal structures and soft palate as a result of heroin snorting: a case series.
abstract: BACKGROUND
  The link between nasal inhalation of cocaine and nasal and palatal necrosis is well documented. In contrast, few data are available concerning nasal mucosa necrosis related to heroin snorting. The authors report here the retrospective analysis of 24 cases of orofacial lesions in patients with nasal heroin usage, collected between 2006 and 2012.
  
  
  METHODS
  The cases concern 17 males and 7 females (median age 29.5 (range: 24-42)) with chronic consumption of intranasal heroin (from 2 months to more than 10 years). Six patients had a history of cocaine abuse. The median daily amount of heroin consumption was 5 g (range: 0.5-10). The complications were nasal perforation (11 cases), nasal ulceration or erythema (5 cases), nasal septum necrosis (5 cases), pharyngeal ulceration (3 cases), and palate damages (5 cases). The most common clinical signs and symptoms were nasal pain, purulent sputum, dysphagia, and rhinitis. Maintenance therapy with methadone (19 cases) or buprenorphine (3 cases) was initiated. In 8 cases, the injury improved.
  
  
  CONCLUSIONS
  The potential of heroin to induce destructive orofacial lesions should be considered when nasal damages are observed in patients with drug abuse. A multidisciplinary approach seems to be the most effective means of managing such patients.
authors.affiliation: a Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance , Centre Hospitalier Universitaire , Montpellier , France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Peyrière
authors.forename: Yves
authors.initials: Y
authors.lastname: Léglise
authors.forename: Arnaud
authors.initials: A
authors.lastname: Rousseau
authors.forename: Cesar
authors.initials: C
authors.lastname: Cartier
authors.forename: Valérie
authors.initials: V
authors.lastname: Gibaja
authors.forename: Pascal
authors.initials: P
authors.lastname: Galland
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects*; D006556:Heroin Dependence / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009336:Necrosis / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D009666:Nose / Q000187:drug effects* / Q000473:pathology*; D058850:Opiate Substitution Treatment; D010160:Palate, Soft / Q000187:drug effects* / Q000473:pathology*; D010614:Pharynx / Q000187:drug effects / Q000473:pathology
chemical_list: D002047:Buprenorphine; D003932:Heroin; D008691:Methadone