How To Treat Hole In Nose From Cocaine Use?

Unfortunately septal perforation is one of the most dreaded nasal complications of cocaine abuse. Even tough, most cases of septal perforation are due to other causes, such as recurrent nosebleeds, poor nasal habits, and some systemic diseases, cocaine remains one of the well know causes. Cocaine use is usually associated with also some other nasal damages related to chemical irritation and vascular comprise too. Regardless of the underlying cause, repair of septal perforation remains one of the most challenging and meticulous nasal surgeries. It often involves open approach for optimal exposure of nasal septum and meticulous dissection of the nasal lining to achieve a low tension closure with local tissue rearrangement. In cases of some larger perforations a 2 step surgery sometimes is needed to maximize the chances of a successful closure. The surgery should be done by someone who has extensive experience with this particular procedure with high success rate.

The hole you describe is a septal perforation. This has occurred due to the effect cocaine has on the lining of the nose which is called the mucosa. Cocaine restricts the blood flow to the septum and eventually with continued use the tissue necrose ( or die ). This results is the septal perforation.The most important first step is to stop all cocaine use permanently and wait for the tissues to heal. After this you should consult a very experienced rhinoplasty surgeon who also has experience in nasal reconstruction. Small to moderate sized perforations can be closed by using local tissue from both nasal cavities which is advanced in to the area usually with a graft of tissue in between . For very lasrge perforations it is very difficult surgery which may require a two stage operation or sometimes even taking tissue form another part of the body as a flap.

A septal perforation can occur from a number of reasons including trauma, surgery, auto-immune disease, or intranasal drug use, among many others. It is important to understand the cause of the septal perforation and correct that before fixing the perforation itself. For example, if someone continues to use cocaine or continues to have issues with an auto-immune process, fixing the perforation will likely fail even if things look good initially. It is also important to determine the primary symptoms associated with the perforation, as some patients with perforations actually have no symptoms at all and the holes are discovered incidentally. Some of the common complaints include frequent crusting, nose bleeds, nasal pain, and nasal obstruction. Before addressing anything surgically I also like to make sure we do everything we can to optimize the nasal cavity in the hopes of 1) potentially avoiding surgery and 2) make it more likely that surgery will succeed if we ultimately pursue that route. For me, I have my patients start a regimen of nasal saline rinses 2-3 times daily, vaseline ointment 3-4 times daily, and avoidance of any manipulation of any of the crusts within the nose as this will often lead to more inflammation of the tissues. After we've done this for at least 4-6 weeks, I will see them back and re-assess their symptoms and also the health of their nasal tissue. There are certainly times where this alone improves the symptoms and we can avoid surgery. If we determine that the nasal issues continue to be problematic and it looks like the tissue is healthy enough, we can then discuss surgery which will be largely dictated by the size of the perforation. If this is small, ie less than 1.5cm, we can sometimes just rotate tissue from within the nasal cavity primarily using endoscopes with no incisions on the outside of the nose. If larger, ie greater than 1.5cm, then I frequently recommend harvesting a temporalis fascia graft (small incision in the temple area) folded over a PDS plate via an open rhinoplasty (incision underneath the tip of the nose) type approach. In both these scenarios, I will have patients keep splints in place for at least 3-4 weeks after surgery to keep the graft healthy during the acute healing period. While historically, many providers have recommended against perforation repair due to low repair rates, the newer techniques such as the fascia graft method, have had repair rates in the 90% range in multiple research studies. Because of this, I would typically employ surgical repair over some of the other methods that some suggest such as the septal button which can be cumbersome and painful for patients. If you have a perforation, I would make sure to see a surgeon you feel comfortable with who sees these frequently and can have upfront discussions about the options available.
Hope this helps and best of luck!Kyle Kimura, MD