title: Comprehensive surgical management of cocaine-induced midline destructive lesions.
abstract: OBJECTIVE
  This article presents a review of the literature and proposes a protocol for managing acute and chronic midfacial cocaine-induced injuries.
  
  
  METHODS
  This report describes a series of 4 patients affected by cocaine-induced midline destructive lesions. Three patients came to the authors' attention after 18 months of drug withdrawal and underwent surgical treatments to restore nasal and palatal morphology and function, and the fourth patient was referred because of acute cocaine-induced destructive lesions and was treated by aggressive debridement. An 18-month drug-free period is planned before beginning any reconstructive procedures in this latter patient.
  
  
  RESULTS
  Long-term follow-up showed stable results without relapse of palatal fistulas and good esthetic nasal appearance in all 3 patients undergoing reconstruction. The fourth patient did not show any disease progression and will be monitored for drug withdrawal.
  
  
  CONCLUSIONS
  Chronic cocaine consumption may cause multiple types of damage to the soft and hard tissues of the midface. Acute lesions must be addressed with aggressive debridement. As a result of chronic injury, the palate and nose are deformed in a very complex way and the vascularity of the remaining local tissues may be compromised or inadequate for flap harvesting. Palatal and nasal reconstructions are very delicate operations and should be addressed separately to maximize the predictability of the result.
authors.affiliation: Assistant Professor, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy. Electronic address: giacomo.colletti@gmail.com.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Colletti
authors.affiliation: Consultant, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Autelitano
authors.affiliation: Professor, Department of Oral Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Chiapasco
authors.affiliation: Professor, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Biglioli
authors.affiliation: Resident, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Giovanditto
authors.affiliation: Adjunct Professor, Department of Otolaryngology, University of Verona, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mandalà
authors.affiliation: Assistant Professor, Department of Maxillofacial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Allevi
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000002:abnormalities / Q000601:surgery; D009668:Nose Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D021362:Palate, Hard / Q000002:abnormalities / Q000601:surgery; D019651:Plastic Surgery Procedures