A 23-year-old man presented to an American outpatient clinic complaining of painful swallowing and hoarseness for two days. The symptoms began immediately after he inhaled nitrous oxide, also known as laughing gas, through his mouth from a canister. Examination revealed redness, swelling, and mucosal detachment of the soft palate and uvula, as well as the posterior wall of the oropharynx. No straining or stridor was noted. Nasolaryngoscopy revealed ulceration and swelling of the right vocal cord. Doctors Michael Patrizio and Meredith Hayden of the University of Virginia shared this case in The New England Journal of Medicine.
Based on the patient's medical history and examination results, he was diagnosed with frostbite of the soft palate, pharynx, and larynx due to nitrous oxide inhalation. This gas is used for anesthesia and can be used for non-medical purposes. It is stored in pressurized cylinders as a liquid, and due to evaporation and expansion upon sudden release, the gas and cylinder rapidly cool, which can lead to contact frostbite. The patient was prescribed over-the-counter analgesics, lidocaine gel, and the glucocorticoid triamcinolone for topical application. He failed to return for a follow-up examination.
