Cocaine-induced destruction of the palate: a diagnostic and management challenge

Cocaine usage is increasing at a rate faster than population growth worldwide. The habitual and chronic insufflation of pulverised cocaine is associated with the progressive destruction of the osseocartilaginous structures of the midface, termed cocaine-induced midline destructive lesions (CIMDLs). These entities present a challenging diagnostic picture, mimicking other infectious, malignant and inflammatory conditions associated with midface destruction. CIMDLs can present along a wide spectrum of disease, with minimal palatal perforation to extensive sinonasal destruction. With the increasing usage of cocaine, there is likely to be a concurrent increase in patients presenting to emergency departments with these destructive entities. Therefore, there is a need to create awareness of this uncommon entity and to document a systematic approach that must be adopted to reach a definitive diagnosis which will subsequently inform management. We report three clinical cases of CIMDLs at varying stages of the disease process which presented to the Dublin Dental University Hospital between January 2023 and June 2024 and document their multidisciplinary management from initial presentation to eventual treatment.