Oronasal fistula associated with narcotic substance abuse: a case report

An oronasal fistula, defined as an abnormal communication between the oral and nasal cavities, most frequently results from surgical trauma, infection, or neoplasia. Nevertheless, chronic abuse of intranasal narcotics, especially cocaine, is an increasingly acknowledged etiological factor. This case report intends to present a clinical instance of a cocaine-induced oronasal fistula and to discuss the pathophysiology, diagnostic procedures, and surgical management approaches based on a review of current literature. Case Presentation: We present the case of a 45-year-old male with a history of chronic cocaine abuse who developed a symptomatic oronasal fistula. Diagnostic computed tomography (CT) revealed destruction of the vomer bone and a fistulous tract. Under general anesthesia, the defect was successfully repaired via a two-layer palatal plastic surgery technique. Conclusion: This case highlights the serious orofacial consequences associated with substance abuse. The effective management of drug-induced palatal perforations requires a multidisciplinary approach, involving surgical intervention and addressing the underlying addiction to prevent recurrence. Early detection and intervention are vital for ensuring optimal outcomes.