We report what we believe to be only the 10th case of palatal necrosis secondary to cocaine abuse in a 33-yearold female patient. Extensive necrosis also involved the cartilaginous and bony septum and paranasal sinuses. Following exclusion of other mid-line destructive diseases her treatment involved saline douches and cessation of cocaine. She remains under review within the department with no evidence of progressive disease. We present a review of the other nine cases of palatal necrosis reported in the world literature and demonstrate a greater incidence in female users. The various presenting conditions of cocaine abuse encountered within the head and neck region by the otorhinolaryngologist are then discussed.