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Midfacial necrosis due to the abuse of inhaled cocaine is a new entity that is included in the differential diagnosis of the midline destructive diseases such as Wegener's granulomatosis, polymorphic reticulosis, nasal lymphoma, infections and the idiopathic midline destructive disease. We report the case of a forty-year-old male who presented necrosis of the nasosinusal tract and optic neuropathy as complications due to the abuse of inhaled cocaine for more than twenty years and a discussion about the differential diagnosis.
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