RESUMO
Destruction of the osteocartilaginous framework of the nose and sinuses is a well-known side effect of inhaled cocaine. Palate involvement is, however, a very uncommon event that may lead to oronasal communication with the subsequent food and liquids reflux and nasal speech. Given the addictive character of this etiologic agent, the management of cocaine-induced palatal perforations tends to be conservative by means of a prosthetic obturator. In this paper three cases with surgically treated cocaine-induced palatal perforations are reported and a review of the literature is made focusing on the management of this process. Despite the usual reluctancy, surgical palatal reconstruction should be considered in selected committed patients as a definitive solution for the annoying rhinolalia and solid-liquid reflux to the nose, thus improving their quality of life and social relationships. Key words:Cocaine, oral fistula, palate, palatal perforation, oronasal communication.
RESUMO
PURPOSE: A simple technique is described for alveolar reconstruction in cases where resorption has already occurred. The palatal core graft allows immediate regeneration of vertical, horizontal, and combined defects at the alveolus with minimal donor site morbidity and time consumption. MATERIALS AND METHODS: Seventeen patients (10 female and 7 male) were treated over a 1-year period. Bone core grafts from the palatal vault were harvested with a trephine and used for alveolar reconstruction in the esthetic zone. Patient age and gender, type and location of the defect, size of the graft, simultaneous tooth removal, simultaneous implant placement, need for soft tissue coverage, and postoperative complications were recorded. RESULTS: Mean length of the grafts was 12.5 mm (range 9 to 14 mm). Mean width was 7.3 mm (range 5 to 9 mm). In 11 cases, simultaneous tooth removal was performed and a connective tissue flap with posterior pedicles was used. Patients did not experience discomfort in the donor area. Sixteen cases were successfully restored with single implants and crowns DISCUSSION: Material for osseous reconstruction should ideally be autologous and easy to harvest and provoke minimal morbidity. The palatal core graft compares favorably with previously described techniques and donor sites for alveolar reconstruction. CONCLUSION: In this preliminary report, experience with a new technique for alveolar reconstruction is presented. The "palatal core graft" for alveolar reconstruction is effective and easy to harvest and has low donor site morbidity, allowing 3-dimensional restoration of alveolar defects.