1. COCAINE-INDUCED MIDLINE
DESTRUCTIVE LESION
• Intra-nasal inhalation is known to cause mucosal inflammation
• Patients predisposed to produce ANCA
• Pathology :-
• Nearly 90% have a positive p-anca against human neutrophil elastase (HNE) which may cause
increase apostosis and the local inflammatory response to injury.
2. Clinical features
• Rarely systematic symptoms
• Chronic nasal obstruction and bleeding
• Change in shape of the nose and nasal regurgitation
• Variable degree of destruction of the septum, turbinates, lateral nasal
wall and floor.
3. Treatment
• No role in immunosuppression
• Must stop using cocaine to prevent further progression
• Conservative treatment includes nasal douching, debridem of
necrotic area and topical or systemic antibiotic therapy
• Surgical correction of septal perforation and nasal deformity should
not be attempted until the patient has been clear of cocaine for
atleast 6 to 12 months.
4. Non healing of midline granuloma
Synonyms
• Stewarts granuloma
• Midline lethal granuloma
• Polymorphic reticulosis
• Sinonasal Lymphoma
• T/NK cell Lymphoma
Aetiology- caused by the Epstine-barr virus.
5. Clinical features
• Usually present with the aggressive destruction of the middle of the
face
• Usually arrises in the nasal cavity and spreads to involve adjustcent
structures including the orbits, oral cavity , skin and paranasal sinuses
• Intra-nasal granulomatous mass initially causes symptoms of the
obstruction , discharge and bleeding
