(BMJ)—A man in his 20s presented with progressive pain and swelling of the oral cavity after inhaling nitrous oxide at a party in Amsterdam. Exam: swollen lips, mouth, and cheek; necrosis of oral mucosa. What’s the dx?
Ludwig angina
Frostbite
C1-esterase inhibitor deficiency
Angioedema
Oral hematoma
You are correct. The patient developed severe frostbite after placing his lips over the valve of the nitrous oxide tank and inhaling the gas. He was admitted to the ICU for pain management and for monitoring because of concerns about airway obstruction due to excessive swelling of the lips, mouth, and cheeks. Oral hygiene was advised for the mucosal necrosis and antibiotics were given to prevent secondary infection.

Recreational exposure to cryogenic agents, such as laughing gas, can cause cutaneous or oral mucosa injuries within minutes. Upper airway compromise can be life threatening; consider monitoring in the ICU to ensure prompt intervention, if required.

BMJ 2021;373:n1441