Microscopic and macroscopic findings in cocaine and crack airways injuries: a literature review.

Cocaine inhalation - and its popular derivative known as crack cocaine - is linked to numerous complications and organ damage, well-recognized in scientific literature, including airway injuries. Airways damage is probably due both to thermal damage by hot vapor and micro-inhalation of crystals, leading to foreign body trauma and inflammation. A brief description of findings is helpful to health professionals - including forensic pathologist - to achieve the correct diagnosis. Our study is of a review of the literature with the aim of investigating the anatomical and pathological basis of damage of upper airways in cocaine crack chronic users. For this purpose, scientific studies that explore the correlation between symptoms related to airway injuries and the corresponding macroscopic and microscopic organ damage in chronic cocaine and crack users were reviewed. Results from 11 studies were reported, involving patients with a history of pharyngodynia, dysphagia, dysphonia, foreign body sensation, and respiratory difficulties. Diagnoses were confirmed through direct or indirect laryngoscopy, with the use of a fiberoptic bronchoscope or flexible endoscope. Macroscopic findings documented edema and inflammation of the epiglottis, false vocal cords, aryepiglottic folds, arytenoid cartilages, and piriform sinuses, and the presence of white plaques and pseudomembranes. Microscopic findings documented inflammatory tissue and necrosis, in one case squamous metaplasia. Our results showed that it is possible to find macroscopic and microscopic lesion in chronic abusers' upper airways and it lays the foundation for future studies in the investigation of the injuries mentioned in post-mortem examinations.