Objectives: The objectives of this article were to provide a review of published cases of frostbite injuries of the head and neck associated with abuse of nitrous oxide (NO) abuse and summarize other the pathophysiologic consequences.
Methods and materials: A literature search was undertaken for articles on the development of frostbite injuries to the head and neck from recreational use of NO, including review papers, clinical investigations, case reports, case series, cohort studies, and letters to the editor. Relevant articles were ascertained from the electronic databases of PubMed and Google Scholar from extending January 1, 1985 through July 5, 2025 and from references cited within culled sources.
Results: The search identified 13 articles, involving 16 patients, with NO-related frostbite injuries to the head and neck. Commonly affected sites included the face, lips, oropharynx, and palate. Six patients required hospital admission, including 3 who were referred to the intensive care unit.
Conclusions: Oral healthcare practitioners should be aware of contemporary modalities of substance abuse, particularly from recreational use of NO and consequent risk of frostbite to the mucocutaneous structures of the head and neck. Attending clinicians are advised to educate their patients about the potential for these injuries from recreational NO abuse.
Keywords: Adverse effects, cold thermal burns, frostbite injuries, head and neck, nitrous oxide, recreational abuse, substance abuse
