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To the Editor.—There has been much discussion about cocaine nowadays, and I would like to mention that some patients who smoke cocaine might present with subcutaneous emphysema of the neck and mediastinum.
It seems that the potent vasoconstrictor effect of cocaine may produce necrosis of the mucous membrane of the larynx in those who smoke cocaine in the same way that it does with the nasal septum in those who snort it.
In a single case I recently encountered, the first complaint was that of pain and discomfort in the region of the throat and neck; this was associated with a noticeable swelling of the soft tissues of the neck, giving it the appearance of that of a bullfrog. Simple pressure on the swelling elicits the sensations of crepitations. There was also a change in the patient's voice from the air leaks secondary to the laryngeal perforation.
JACOBS LM, SCHWARTZ RJ. Subcutaneous Emphysema and Cocaine: A Rare Case-Reply. Arch Surg. 1987;122(5):619-620. doi:10.1001/archsurg.1987.01400170125021