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Introduction: Chronic use of cocaine provokes vasoconstriction and irritation of the upper airway epithelium. These mechanisms can lead to tissue necrosis and perforations., Case Report: A 37-year-old woman had major centrofacial necrosis subsequent to chronic inhalation of cocaine. The tissue loss involved the right wing of the right ala nasi, the bony and soft palate and nearly all of the lateronasal walls. A microanastomosed antebrachial fasciocutaneous flap was used for reconstruction of the nasal vault. A classical veloplasty was used to close the palate. Velar competency was improved with a second procedure with Ortricochea sphincter pharyngoplasty. Later loss of the antebrachial flap required salvage with a flap from the lateral border of the tongue which provided a satisfactory functional result., Discussion: This case of extended necrosis is rare and treatment was complex. Such treatment can only be undertaken after total and definitive cessation of drug abuse, including tobacco smoking.

The main aim in lip reconstruction is to recreate a sphincter activity and obtain lip balance. Careful evaluation of the defect is essential and will lead the surgeon to choose the best and most suitable procedure. Wedge excision with direct suture, opposite full-thickness lip switch flap and Karapandzic procedure are presented in this paper. The axiom is "Use lip to repair lip".

The use of a new alloplastic biodegradable implant called BIOFIX made of polyglycolate is described. We used it to cover bone defects in maxillo-facial surgery, principally for orbital floor restoration and frontal sinus repair, with very good results. It is an excellent material of temporary support and guidance during the healing period and new bone formation. However, it will be necessary to wait for the results of a multicentric european study to confirm its superiority in maxillofacial surgery.