35th AM (2024) - Poster Session-Case Report: Extensive oronasal damage in a person using fentanyl and xylazine

Case Report: Extensive oronasal damage in a person using fentanyl and xylazine

Pdf Summary

This case report outlines severe nasal, palate, and skull base destruction in a 39-year-old woman (referred to as AC) linked to intranasal use of fentanyl and xylazine. It highlights significant soft tissue and bony structure damage, including a saddle nose deformity and oronasal fistulas, discovered upon examination after AC sought medical help for Gatorade reflux into her nasal cavity. AC had a history of opioid use starting with prescription opioids and escalating to fentanyl, ultimately compounded with xylazine, an alpha-2-adrenergic agonist increasingly found in the illicit drug supply since approximately 2022.<br /><br />The report underscores the introduction of xylazine into the fentanyl supply as a likely contributor to the observed damage, citing xylazine's ability to reduce sympathetic outflow, induce vasoconstriction, and thus cause tissue necrosis and destruction. Before this case, such extensive nasal destruction had not been linked to fentanyl or xylazine. The case reflects a broader public health issue regarding the rising prevalence of xylazine as a fentanyl adulterant, which could lead to similar cases in the future.<br /><br />AC's case demonstrates the clinical need to address opioid use disorder (OUD) and manage withdrawal symptoms to prevent further substance-induced damage and facilitate surgical repair. It highlights the importance of healthcare providers recognizing distinct nasal damage related to fentanyl and xylazine use and ensuring timely referral to specialist care and substance use disorder treatment. The study concludes with recognition of the shifting landscape in opioid supply and the need for increased testing and awareness to mitigate such adverse health effects.

Keywords

nasal destruction

fentanyl

xylazine

saddle nose deformity

oronasal fistulas

opioid use disorder

tissue necrosis

public health issue

substance use disorder

opioid supply

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