Case Report: Oral-Nasal Damage in a Person Using Fentanyl and Xylazine

Background: Xylazine, an alpha-2-adrenergic agonist, was added to illicitly manufactured fentanyl within the past decade. Intranasal drug use is common and associated with damage to nasal structures and the palate. There have been no case reports detailing intranasal damage secondary to fentanyl and xylazine use. Case Summary: We present a case of a 39-year-old woman with a long history of intranasal opioid use and, more recently, xylazine use who presented for treatment due to nasal septum perforation and oral-nasal fistulas. She started treatment for opioid use disorder and was referred to otolaryngology for further examination and treatment of palate damage thought to be secondary to intranasal fentanyl and xylazine use. She exhibited severe damage to her palate, nasal structures, and skull base. Clinical Significance: This case illustrates damage to the nose, palate, and skull base, likely secondary to co-use of fentanyl and xylazine intranasally. It is important for clinicians to recognize that nasal damage may result from fentanyl and xylazine use and refer to appropriate substance use disorder and otolaryngology treatment to prevent further destruction.