Injection laryngoplasty with hyaluronic acid (HA) is currently the first-line treatment for glottic insufficiency, significantly improving vocal function. Some rare inflammatory laryngeal reactions have been reported, managed conservatively by corticosteroids and antibiotics.

An 83-year-old woman with longstanding dysphonia due to left laryngeal paralysis was treated by medialization with hyaluronic acid injection under local anesthesia. Postoperative course featured onset of dyspnea 42 h after injection, with a large laryngeal edema, unimproved by conservative medical treatment. CT showed edematous infiltration of the left hemilarynx, greater than the injected volume. Given the lack of clinical improvement, emergency tracheotomy was performed. Progressive absorption of the edema allowed decannulation 3 weeks later.

We report a rare complication after medialization by HA injection: a severe inflammatory laryngeal reaction significantly impairing airway function and threatening vital prognosis. The case highlights the critical need for close monitoring after medialization and for appropriate management in case of dyspnea onset.