The office of National Drug Control Policy estimates that there are currently upward of 3.6 million chronic cocaine users in the United States. There are four primary methods of ingesting cocaine: snorting, injecting, and smoking it as a freebase or as crack cocaine. Intranasal inhalation of cocaine or snorting has known deleterious effects on the local tissues of the nasopharynx.(1-5) Most commonly, necrosis of the nasal septum resulting in septal perforations is seen. Less is known about the effects of intranasal inhalation of prescription narcotics. 6,7 Loss of the nasal septum, a major structural support for the nasal dorsum, can lead to complete nasal collapse. Septal perforation can result in speech distortion. Loss of the hard or soft palate can have even more devastating consequences, including uncontrollable oronasal regurgitation, loss of speech intelligibility, and secondary middle ear dysfunction. Reconstructive options are similar to those when dealing with a cleft palate or a cleft lip nasal deformity. Long-term outcomes, however, may be expected to be less favorable in acquired palatal defects because of scar tissue formation not seen in congenital deformities.
