Intranasal tissue necrosis related to opioid abuse: Case report and systematic assessment.
Laryngoscope. 2017 Dec 27;:
Authors: Morrison DA, Smart SK, DelGaudio JM, Chowdhury NI, Levy JM
OBJECTIVE: Opioid abuse is a standard dysfunction affecting over 2 million People. Intranasal tissue necrosis is a beforehand described sequela of nasal opioid inhalation, with an analogous presentation to invasive fungal rhinosinusitis (IFRS). The purpose of this case report and systematic assessment is to guage the proof supporting this unusual illness, with qualitative evaluation of the presentation, administration and therapy outcomes.
DATA SOURCES: MEDLINE, EMBASE, Google Scholar, Scopus, and Internet of Science.
REVIEW METHODS: Most popular Reporting Gadgets for Systematic Critiques and Meta-analyses tips have been utilized to establish English-language research reporting intranasal mucosal damage related to prescription opioid abuse. Major outcomes included scientific presentation, therapy methods, and outcomes.
RESULTS: Systematic assessment recognized 61 sufferers for qualitative evaluation. Widespread scientific options embrace facial ache with out a historical past of continual sinusitis or recognized immunodeficiency. Diagnostic nasal endoscopy revealed superficial particles with underlying tissue necrosis, according to a preliminary prognosis of IFRS. Attribute pathologic findings embrace mucosal ulceration with an overlying acellular substrate, usually with polarizable materials. Fungal colonization is commonly reported, with a number of accounts of angiocentric invasion in immunocompetent sufferers. Full symptom decision is predicted following surgical debridement with cessation of intranasal opioid inhalation, with 89% of recognized sufferers experiencing an entire decision of illness.
CONCLUSION: Intranasal opioid abuse is a prevalent situation related to continual ache and tissue necrosis that’s clinically regarding for invasive fungal illness. Whereas IFRS have to be excluded, even in sufferers with out recognized immunodeficiency, full decision of signs could be anticipated following surgical debridement with cessation of opioid abuse. Laryngoscope, 2017.
PMID: 29280484 [PubMed – as supplied by publisher]