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Narcotics:   Case 1:  This video is of a 45 year old male patient with a history of narcotic abuse.  The patient developed mild intranasal pain and changes in his voice.  In addition, food and liquids entered his nose when he ate.   The narcotics used were prescribed by a physician and not obtained on the street.  Shown below are three pictures from the patient.  The far left picture shows necrotic tissue inside the right nose.  There is extensive dead tissue plus a perforation of the nasal septum can be seen.  The center picture shows the appearance of the left naris.  Note that only the lower margin of the middle turbinate is necrotic.  The right hand picture shows a perforation of the soft palate which was caused by tissue necrosis due to intranasal narcotic use.    Click on Pictures to Enlarge

  
Treatment required multiple endoscopic nasal debridement and withdrawal from narcotic usage.  Once the mucosa has healed the patient's soft palate (roof of the mouth) hole can be repaired using a pharyngeal flap.   The nasal septal perforation may cause bleeding, whistling and crusting.  Usually, these symptoms can be held at bay using nasal rinses.  However, if persistent, operative repair or placement of a nasal septal button may be beneficial.  

Case 2:  This video is of a 48 year old male who is seen with a three day history of left facial pressure and decreased nasal airway.  The patient had chronic pain and was on prescription narcotics.  

Shown below are three pictures from this patient.  The left-hand picture shows abundant mucosa and debris underneath the left inferior turbinate.  The middle picture shows dead mucosa above the left inferior turbinate and adhesions between the inferior turbinate and nasal septum.  The far right picture shows some of the necrotic mucosa that was removed from the nose. 
 

As with case #1, treatment involves multiple endoscopies to clean the naris and withdrawal from narcotic usage. 
 
 

 
This picture shows "Meth Mouth" or the appearance of the patient's mouth after using methamphetamine.  Extensive dental caries are present which will require extraction of all the patient's teeth.  Loosing all of ones teeth at a young age can lead, over the course of years, to absorption of the mandible (jaw bone) with loss of the ability to have good fitting dentures.  In addition, the loss of vertical height of the biting service can lead to temporal mandibular joint (TMJ) syndrome with chronic pain and arthritis in the jaw joint.  

This type of drug abuse is common in the US and in the Appalachian Mountain Region.  For more information go To Operation UNITE's website.  

Note Pictures Courtesy of:  Sharlee Shirley-Burch, RDH, MPH; University of Kentucky, College of Public Health
    

Meth Mouth   Click on Pictures To Enlarge 

   
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