Vocal cord paralysis resulting from neck injections in the intravenous drug use population

Abstract

Intravenous drug use patients present to the head and neck surgeon when injections are directed "in the pocket," or more appropriately, toward the internal jugular vein in the neck. The more common complications of this practice include the development of cellulitis, abscess, and venous thrombophlebitis and, potentially, pulmonary embolism and pseudoaneurysm of the carotid and subclavian arteries. Vocal cord paralysis as a result of neck injection in the intravenous drug-using population is rarely described, and a review of the literature has yielded only two reports addressing this uncommon phenomenon. During a 7 1/2-year period between October 1981 and June 1989, nine patients presented to Detroit Medical Center with hoarseness, upper-airway obstruction, or both following the injection of heroin or related substances into the neck. Otolaryngologic evaluation demonstrated unilateral or bilateral vocal cord paralysis coincident with recent neck injections. The clinical signs and symptoms, location of the injections, acute management, and subsequent complications are catalogued. Acute management of these patients consisted of airway assurance via tracheotomies when indicated and observation for the development of cellulitis, abscess, or more life-threatening neurovascular complications. Follow-up laryngeal examinations ranged from 4 months to 4 1/2 years and found no demonstrable return of vocal cord function in any of the nine patients.

Increasing Heroin‐Methamphetamine (Goofball) Use and Related Morbidity Among Seattle Area People Who Inject Drugs

“…Injecting into the jugular vein was reported by over one‐half of people whose main drug was goofball. Jugular vein injection can lead to serious sequelae, including deep soft tissue infections, 18 internal jugular vein thrombosis (Lemierre's syndrome) and septic thrombophlebitis, 19 pneumothorax, 20 and vocal cord paralysis 21 . Injecting into central veins may be more expected among older PWID who have difficulty injecting into peripheral veins due to scar tissue, but we observed that PWID who use goofball were the youngest group and correspondingly had the shortest period of time since the first injection.…”

Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico

“…In addition, veins that pass by the neck are substantially larger than those in the arm (where injection drug use is more frequent), which could lead to increased risk of circulatory problems or other life‐threatening infections [4,6,9]. Injecting in the neck has been related to adverse health conditions such as deep neck infections that may develop abscesses and related complications such as haematomas, airway obstruction, vocal cord paralysis, wound botulism, extension of infection to other structures, pneumothorax, mycotic subclavian carotid artery aneurysm, paraplegia and internal jugular vein thrombosis, among others [4,5,9–17]. Internal jugular vein thrombosis is associated with pulmonary embolism, cancer and recurrent venous thromboembolic events [6,18].…”

Unilateral true vocal fold paralysis: Cause of right‐sided lesions

“…Nonsurgical trauma accounted for 3 (13%) cases of right vocal fold paralysis (head injury [1], cervical fracture [1], intravenous injection [1]). Vocal cord paralysis from attempted jugular vein injection by chronic drug abusers, although rare, has been described in the literature 4 , 5 and was the cause of one (4%) of our patient's paralysis. Intubation injury was not seen in our population as has been described with left vocal fold paralysis.…”