Cocaine-induced midline destructive lesions

caused by cocaine insufflation (pictured) can progress to cocaine-induced midline destructive lesions Patients with CIMDL present with chronic nasal obstruction, hyposmia, nose bleeding, and severe facial pain. More advanced cases present nasal septal perforation, diffuse necrotizing ulcerative lesions, nasal deformation, and palatal perforation. albeit with some absent systemic symptoms such as fever, arthralgia, myalgia, CIMDL can be differentiated from systemic conditions. ==Pathophysiology==

Although not entirely understood, CIMDL is thought to be caused mainly by the vasoconstricting effects of cocaine, which induces ischemia and subsequent necrosis of the mucosal lining, followed by damage to nasal cartilaginous and bony structures. ==Treatment==

The only reliable treatment of CIMDL is cessation of cocaine abuse, which is considered a necessary prerequisite for surgical reconstruction. If abstention can be achieved, reconstructive surgery, prosthetics and medical therapy can achieve satisfactory results. Conservative treatment consists of regular saline douches, debridement of necrotic tissue and administration of antibiotics. ==See also==