This case report is of a 29-year-old male who complained of nasal escape of food and fluids through his nose for 6 months. Further questioning revealed a previous cocaine habit which has now ceased. Examination revealed a septal perforation and CT scanning revealed a 16 mm wide sagittal bone defect involving most of the hard palate as well as absence of the inferior half of the nasal septum. A diagnosis of septal perforation leading to an oro-naso-palatal fistula was made. This rather unusual presentation and clinical findings are discussed within this article.
CPD/Clinical Relevance: The effects of cocaine misuse on the oral mucosa are presented.
Article
A 29-year-old Caucasian male presented with a 6-month history of nasal escape of food and fluids. He reported constant pain over the bridge of his nose and frontal bone region. He also reported blockage of his nasal airway. There was no history of nasal bleeding or discharge.
The examination was undertaken by a Consultant in Oral and Maxillofacial Surgery. The patient's nose demonstrated good dorsal height and projection. The nasal tip was well supported. On intra-oral examination he was fully dentate with a well maintained, minimally restored dentition. There was a defect within the midline of the hard palate approximately 1.5 cm in width, which was temporarily occluded with ‘igloo gel’ (Figure 1).
Intra-nasal examination under good light and a nasal speculum (Figure 2) revealed a large septal defect which extended from the columella posteriorly to include the entire cartilaginous and bony septum. In effect both nasal cavities were in continuity.
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