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Nowadays in Western Countries the use of cocaine by inhalation is increasing and its use is superseding heroin in rising generation. Young people of third millennium use narcotics to keep them away from negative conditions of daily life and to refuge themselves in “unreal” trips as it happened in the ‘60s and ‘70s for heroin addicted. 

Today, on the contrary, people addicted to cocaine want to be more competitive and “winner” and believe that cocaine can help them to reach this goal. 104 patients have been observed for 2 years, aged between 16 and 54, (75 male and 29 female), all habitual inhaling cocaine users (≥10 times per month). Among them, 11 (10.5%) had nasal septal perforation, which is a frequent complication related to cocaine use. Amomg these 11 patients, 8 patients (72.7%) had nasal septal perforation of the quadrangular cartilage, while fot the other 3 (27.3%) the perforation involved also the bony tract (vomer-perpendicular ethmoidal lamina). Psychological analysis of all 104 patients reported: 62 patients (59.6%) answered that they inhaled cocaine to improve endurance and to feel stronger and less tired; 34 patients (32.7%) to enjoy themselves more during parties and to communicate more effectively with other people; 5 patients (4.8%) to gain confidence and to overcome their shyness, 2 patients (1.9%) to improve their sexual performance and 1 patients (1%) to drink more alcoholic drinks for longer time without feeling sleepy. All the patients have been undergone a psychotherapeutic treatment, but the swinging compliance and constancy in following the scheduled follow-up visits consented to carry through the therapy only for 16 patients (15.3%). All the patients with nasal septal perforation underwent at T0 to rhino-endoscopy with 0°, 45° endoscopes, CT scan of nose and paranasal sinuses and biopsy. At the moment of the observational period none of the 11 patients who presented nasal septal perforation consented to stop abuse of cocaine; therefore a temporary solution has been offered all the patients (accepted by 3 of them), i.e. the positioning of a silicone button to close the perforation and, so, improve the air flux in the nose and reduce the progression of local necrosis. Is described the positioning under local anaesthesia together with the button of two layer per septal side of hyaluronic acid at different level of esterification, kept in site by the button as a “sandwich” in order to obtain a better re-grow of mucosa and less crusts and bleeding