Isolated laryngopharyngeal thermal injury caused by microwave-heated chocolate

Laryngopharyngeal thermal injury from ingested food is uncommon in adults. When accompanied by laryngeal oedema, it can progress to life-threatening airway obstruction. We report a case of laryngopharyngeal thermal injury in an otherwise healthy man in his 20s after ingesting microwave-heated homemade chocolate. The chocolate was fed to the patient by another person using a spoon while his neck was extended. Although the surface appeared solid and cool, the interior had reached a high temperature. Unable to expectorate the bolus, the patient swallowed it, sustaining a direct thermal insult to the laryngopharynx without visible oral mucosal burns. Laryngoscopy the following day revealed marked erythema and oedema of the right arytenoid region and epiglottic laryngeal surface. He was treated with intravenous methylprednisolone and ampicillin/sulbactam and discharged on day 3. This case highlights that neck extension during feeding can allow hot material to pass through the oral cavity too rapidly to permit protective reflexes and directly injure the laryngopharynx, even with solid foods.