The clinical manifestations of cocaine-induced midline destructive lesion: a real challenge for maxillo-facial surgeons, mapping evidence review

BaCKgrOuND: Nasal septa perforations represent the most common complication of cocaine snorting, being present in about 5% of these drug's abusers. a cocaine-related syndrome, named cocaine-induced midline destructive lesion (CiMDL), characterized by centrofacial midline necrosis, has been described in scientific international literature. Pathophysiologic factors involved in CIMDL are both cocaine and adulterants. Cocaine produces a sympathetic-mediated vasoconstriction causing ischemia of cartilage and mucosa, while powdered substances such as talc, mannitol, lactose, amphetamines and borax act like chemical irritants on the mucosal lining, leading to inflammation and ulceration. In the differential diagnosis of centrofacial destructive processes, CIMDL can be considered the first diagnostic choice in developed Countries. The objective of the current investigation was to characterize, from the authors' experience and literature data review, the great variety of oral and maxillo-facial lesions produced by cocaine use and abuse. METhODS: The authors have extensive, long-term experience with a patient cohort occasionally willing to admit their addictions and recreation-al drug uses. Our observations of this patient's cohort, and from other similar cases reported in current scientific international literature relative to oral and maxillofacial lesions apparently resulting from direct placement of cocaine/crack powder/smoking on oral mucosal surfaces or use of glass or clay pipes to inhale the drugs, are herein summarized. The mapping review was carried out based on the indications of the PriSMa and referring to the indications provided by James et al. in the publication entitled: a methodology for systematic mapping in environmental sciences. RESULTS: Oral and maxillo-facial effects were identified by the authors, according to literature, as a consequence of repeated use of this drug. The most described, included: 1) hard palate osteonecrosis, perforated septum from recurrent interaction with cocaine; 2) typical saddle-nose deformities; 3) mucosal and gingival manifestations, including retractions, ulcerations and keratosis; 4) heat damages, from glass or clay pipes to inhale the drugs. CONCLuSiONS: CiMDL is an emerging health problem due to cocaine abuse. The diagnosis of these lesions can be challenging because nu-merous conditions can present with similar signs and symptoms.