Background and objectives : Cocaine consumption can induce centrofacial midline necrosis producing complex defects which require difficult reconstructive combined techniques. Our objective is to describe and discuss the reconstructive possibilities for palatal and nasal defects produced by this aetiology.

Materials and methods : A retrospective review was done of the cases treated by our Department which developed centrofacial midline defects due to cocaine consumption. We describe the anatomical defects and the reconstructive methods performed.

Results : A total of 6 patients were treated. All cases developed palatal defects with oronasal communication, and 3 patients had combined nasal deformity. For the nasal defects either local pedicled flaps or grafts were used. For the 6 palatal defects 5 free flaps were used (2 radial forearms, 2 ALTs and 1 anterolateral arm). The remaining palatal defect was treated using a bilateral FAMM flap, which failed, and an ALT was performed.

Conclusion : Reconstruction of central midfacial defects developed by cocaine consumption can be challenging. The combination of free flaps, pedicled flaps and grafts can be used to reconstruct defects which are usually located in the hard palate but can also involve the nose and soft palate.

Key words : cocaine; nasal deformity; oronasal communication; reconstruction