The 81st Annual Meeting of the American Association of Physical Anthropologists (2012)

Osteological manifestation and diagnosis of Cocaine-Induced Midline Destructive Lesion: A new understanding of an overlooked condition and its relevance to forensic anthropology


Anthropology, University of Pennsylvania

Thursday All day, Plaza Level Add to calendar

Cocaine-Induced Midline Destructive Lesion (CIMDL) has never been described from the osteological perspective despite the significant destruction of bone it can cause. Although several clinical publications describe case studies, the bony changes associated with CIMDL are rarely described in any real detail. Many authors write them off as "non-specific," yet admit that they are uncertain of what these changes entail. The present study suggests that greater focus on the osteological manifestations of CIMDL may aid both clinical and forensic diagnosis.

This study analyzed 88 published cases of CIMDL to synthesize a new understanding of its osteological effect. Of the reported patients, 94% exhibit destruction of the bony septum, and over 52% have perforations in the palatal process of their maxillae. Destruction affects the nasal conchae and the paranasal sinuses to varying degrees; the alveolus is typically spared and the nasal bones proper are unaffected. Evidence, not previously associated with CIMDL, further suggests that cocaine is toxic to osteoblasts and thereby inhibits new bone growth, and in no case report is proliferative or sclerotic bone reaction associated with a primary CIMDL lesion.

The ability to diagnose CIMDL is particularly relevant to forensic anthropology; reports show that drug misusers have mortality rates six-times greater than age-matched populations and that 73% of autopsy subjects with cocaine in their systems die from trauma, 70% due to homicide. Drug abuse is not an uncommon feature of Jane and John Does, and recognition of CIMDL in remains may provide vital insight into their deaths and lives.

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