2025, Vol. 7, Issue 2, Part B

Introduction and Objective: Chronic cocaine use can lead to destructive lesions of the facial midline, which may extend to involve the skull base. In advanced stages, these lesions can cause cerebrospinal fluid leaks, intracranial infections and require complex reconstructive surgery. This article presents the case of a patient with skull base erosion due to prolonged cocaine use, successfully reconstructed with a free rectus abdominis muscle flap.

Case Report: A 36-year-old male with a history of daily intranasal cocaine use for fifteen years was referred with nasal septal perforation, destruction of the hard and soft palate and bony erosion at the clivus region of the skull base. The condition progressed to include leakage of cerebrospinal fluid, bacterial meningitis with associated acute hydrocephalus and pneumocephalus. A multidisciplinary team performed surgical debridement of the skull base using endoscopic techniques guided by a neuronavigation system followed by extended transfacial access. Reconstruction was achieved using a free rectus abdominis muscle flap harvested from the right abdomen and connected to the facial blood vessels on the same side.

Results: The procedure allowed complete coverage of the bony and dural defect. The muscle flap was anatomically adapted and securely fixed with sutures to surrounding bone structures to prevent postoperative displacement. The patient showed a favorable recovery in the early postoperative period, without recurrence of cerebrospinal fluid leakage or intracranial infection.