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Short answer: Yes. Prior intranasal stimulant use—especially cocaine—can cause chronic nosebleeds, crusting, septal perforation, and even palatal perforation without cancer. The tissue damage can persist long after you stop. However, similar findings can also be caused by autoimmune vasculitis (e.g., granulomatosis with polyangiitis), infections (e.g., syphilis, fungal), or malignancy (e.g., sinonasal carcinoma or extranodal NK/T‑cell lymphoma), so it’s important to rule these out.
How to evaluate and confirm
– ENT exam with nasal endoscopy: First-line to directly inspect the septum, turbinates, and palate; helps decide if biopsy is needed.
– Imaging:
– CT scan of the paranasal sinuses/maxillofacial region (often with contrast) to assess bony erosion and defect size.
– MRI if a soft‑tissue mass, perineural spread, or intracranial/orbital extension is suspected.
– Biopsy:
– If there is a mass, atypical tissue, progressive destruction, or unclear diagnosis, a small targeted biopsy from the active edge is recommended to exclude cancer, vasculitis, or infection. Note: cocaine‑related tissue heals poorly; clinicians balance need for diagnosis versus risk, but biopsy is often still necessary when red flags exist.
– Send tissue for histology plus bacterial, fungal, and mycobacterial cultures; immunostains and EBV testing if lymphoma is suspected.
– Blood/serologic tests (to look for noncancer causes that mimic cocaine injury):
– ANCA panel (PR3/c‑ANCA and MPO/p‑ANCA), ESR/CRP
– Syphilis testing (RPR + treponemal confirm), HIV; consider hepatitis B/C
– IgG4 level; ACE and TB screening if clinically indicated
– Urine toxicology (documents abstinence if needed for surgical planning)
Healing and treatment
– Absolute abstinence from intranasal drugs is essential. Many symptoms (bleeding/crusting) improve with:
– Daily saline irrigations or sprays, room humidification
– Gentle emollients inside the nostrils (e.g., petrolatum or lanolin) and avoidance of picking
– Short courses of topical antibiotic ointment if crusting/infection; treat any bacterial superinfection
– Established perforations:
– Nasal septal perforations seldom close on their own once formed; goal is symptom control. A septal button/prosthesis can help if symptoms persist.
– Palatal perforations rarely heal spontaneously; a dental/maxillofacial obturator can immediately improve speech and swallowing.
– Reconstructive surgery (septal or palatal) is considered only after disease is quiet and you’ve demonstrated sustained abstinence (commonly 6–12 months) and after other causes are excluded. Smoking cessation improves outcomes.
– Seek urgent care now if you have brisk/recurrent bleeding, fever with worsening pain or foul discharge, black necrotic tissue, facial numbness/swelling, vision changes, or weight loss.
Bottom line: Past intranasal stimulant use could fully explain your symptoms, but you should have an ENT evaluation with endoscopy, CT imaging, and targeted labs; biopsy if anything looks suspicious. Abstinence plus nasal care often controls symptoms, but established holes typically need a prosthesis and sometimes delayed surgery rather than expecting spontaneous closure.
CONSENSUS DIAGNOSIS: CIMDL
CONSENSUS CIMDL PROBABILITY (0–1, two decimals): 0.81
MERGED ITEMS (Q1–Q10):
Q1: Positive
Q2: Negative
Q3: Positive
Q4: Positive
Q5: Positive
Q6: Positive
Q7: Positive
Q8: Positive
Q9: Positive
Q10: Negative
ADJUDICATOR NOTE (≤5 lines):
– Both summaries diagnose CIMDL; probability averaged to 0.81, and merged items show decisive positives (Q1, Q3–Q6) including stimulant use, nosebleeds, crusting, and palatal lesion.
– Proceed urgently with ENT/OMFS evaluation, endoscopy, CT mapping, and edge biopsy to exclude malignancy/infection/autoimmune disease; strict abstinence and nasal care now.
I’m sorry you’re going through this—it’s stressful and deserves prompt attention. Yes, a past period of snorting stimulants can cause nosebleeds, crusting, septal and even palatal perforations (CIMDL), and your pattern is more consistent with that than with typical mouth cancer, but cancer and other causes must be ruled out. The most useful tests are: CT scan of the nose/sinuses/maxilla to map bone loss; office nasal endoscopy with photos; and a small biopsy from a viable edge of the palate/nasal defect to exclude cancer, infection, or vasculitis; add labs (ANCA, ESR/CRP, syphilis/HIV as indicated) and provide clear photos if seen remotely. Absolute abstinence starting now is critical—irritation, bleeding, and crusting often improve, but larger holes rarely close on their own; a temporary obturator can help with speech/swallowing. Definitive surgery is usually deferred until you’ve been drug-free and the area has been quiet for at least 6–12 months; seek urgent care immediately for heavy or persistent bleeding.
DIAGNOSIS: CIMDL
CIMDL PROBABILITY (0–1, two decimals): 0.84
ITEMS (Q1–Q10):
Q1: Negative — “Liquidsdon’tcomeoutofmynose.”
Q2: Negative — “Myvoicedoesn’tsoundespeciallynasal.”
Q3: Positive — “Mynosefeelsblockedmostdays…Onesidewhistles…”
Q4: Negative — “Idon’tnoticeheavycrusting…”
Q5: Positive — “Igetfrequentnosebleeds…”
Q6: Positive — “Smellsaredullormissing.”
Q7: Positive — “Paincentersinthemiddleofmyface—behindthenoseandattheroofofmymouth.”
Q8: Positive — “There’saraw,non-healingspotattheroofofmymouth…”
Q9: Negative — “Ihaven’thadstrongtreatmentsbefore,justrinsesandoccasionalantibiotics.”
Q10: Negative — “Idon’thavefevers…Ididusenasalstimulantssociallyinthepast…”
SUMMARY (patient-facing, ≤5 lines):
– What we heard: “Onesidewhistles” and “There’saraw,non-healingspotattheroofofmymouth,” with frequent nosebleeds and smell loss, plus past intranasal stimulant use.
– What this might mean: Your pattern fits drug-related midline injury more than a typical mouth cancer, but we must confirm and rule out infections or autoimmune causes.
– Next steps: Strict abstinence now; gentle saline/ointment and no nose-picking; urgent ENT/head–neck visit for nasal endoscopy, CT of nose/sinuses/palate, and a small edge biopsy. If drug-related injury is confirmed, some irritation improves with abstinence, but larger holes rarely close on their own—an obturator can help, and surgery is considered only after months of stable abstinence; seek urgent care for heavy bleeding.
DIAGNOSIS: CIMDL
CIMDL PROBABILITY (0–1, two decimals): 0.78
ITEMS (Q1–Q10):
Q1: Positive — “past period of snorting stimulants”
Q2: Negative — “complete abstinence allow healing?”
Q3: Positive — “nosebleeds”
Q4: Positive — “crusting”
Q5: Positive — “possible hole in my palate”
Q6: Negative — “(not reported)”
Q7: Negative — “(not reported)”
Q8: Negative — “(not reported)”
Q9: Positive — “crusting”
Q10: Negative — “(not reported)”
CLINICAL RATIONALE (≤6 lines):
– CIMDL-leaning features: “snorting stimulants,” “nosebleeds,” “crusting,” and “possible hole in my palate.”
– No OSCC red flags provided (no “nonhealing ulcer,” “indurated mass,” “neck lump,” “weight loss,” or “persistent pain”).
– Pattern fits drug-related midline destructive process; cancer cannot be excluded without exam/biopsy.
TRIAGE (≤3 lines):
– Likely CIMDL: arrange sinonasal endoscopy and maxillofacial CT; begin strict cessation counseling now.
– Obtain targeted biopsies to exclude OSCC/other causes if any suspicious ulcer/induration or progressive destruction is seen.
– Coordinate local ENT/OMFS visit within 1–2 weeks.
AIDOC STEPS (brief, one line each):
1. History: timing/amount of intranasal use, last use, other vasoconstrictors, autoimmune/infectious red flags.
2. Remote documentation: clear photos/video of palate (oral and nasal sides) and any perforation edges.
3. Labs: ANCA (PR3/MPO), ESR/CRP; urine tox (cocaine/levamisole) if recent use suspected; syphilis/HIV as appropriate.
4. Imaging: CT maxillofacial/paranasal sinuses with bone windows to map septum, turbinates, hard palate, and extent of bony loss.
5. Endoscopy: office nasal endoscopy with photo/video to assess crusting, septal defects, active necrosis.
6. Biopsy: sample from viable margin of perforation/ulcer (avoid necrotic center); request routine H&E plus special stains for fungi/AFB as indicated.
7. Immediate care: absolute abstinence; gentle saline irrigations; humidification; avoid topical vasoconstrictors/irritants; analgesia.
8. Prosthodontics: consider temporary palatal obturator for speech/swallowing; defer definitive closure until inflammation quiescent.
9. Surgical planning: if large/stable defect after ≥6–12 months drug-free, discuss repair (local/regional flap or free flap) versus long-term obturation.
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.
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