Laryngeal and Subglottic Necrosis Following Long-Term Heroin Inhalation

While nasal and palatal necrosis secondary to intranasal cocaine use is well documented in the literature, similar presentations linked to heroin abuse are rarely described. To the best of our knowledge, laryngeal involvement has not previously been reported. We present the case of a 48-year-old man with a 25-year history of smoking heroin, who presented with necrotic debris on the vocal cords and in the subglottic region. Debridement was performed, after which the symptoms subjectively improved. After one year, a subglottic adenocarcinoma was diagnosed. Substance abuse, including smoking heroin, should be considered in the differential diagnosis when necrotic laryngeal tissue is observed during laryngoscopic evaluation of patients with dysphonia and dyspnea. Biopsy and debridement are crucial for both diagnosis and symptom management. Long-term follow-up is essential, especially in patients with ongoing substance abuse, as malignancy can develop over time.