Temple Head and Neck Institute
Objective: To present a case of unilateral vocal fold paralysis (VFP) after injection of cocaine and heroin into the neck and to discuss potential pathophysiologic mechanisms and management options of acute VFP secondary to injection injuryMethods/Case Description: We report a case of acute unilateral VFP and a review of the literature. The patient is a 33 year-old female intravenous drug user who presented with hoarseness and dysphagia shortly after injection of intravenous cocaine and heroin into her left lateral neck. Her airway was stable. Flexible fiberoptic laryngoscopy demonstrated an immobile left true vocal fold in the paramedian position. Computed tomography revealed edema of the left carotid sheath. Swallow evaluation showed moderate dysphagia with impaired oral and pharyngeal phase and signs of aspiration with all oral intake.Results: Only a handful of cases of VFP after cervical intravenous drug injection have been reported, last of which was documented in 1990. A comparison between management of the current case and management of previous cases is shared. After 72 hours of observation with no improvement in symptoms, the patient underwent direct laryngoscopy with left vocal fold injection of calcium hydroxylapatite with adequate medialization. Repeat swallow evaluation demonstrated improvement of oropharyngeal dysphagia with no signs of aspiration on oral intake and improved dysphonia.Conclusion: Although uncommon, VFP is a potential complication of cervical intravenous drug injection that should be recognized by the otolaryngologist. Early management of acute unilateral VFP with vocal fold injection medialization may prevent airway and swallow-related complications.