Severe systemic reaction from calcium hydroxylapatite vocal fold filler.

We describe a severe systemic reaction that occurred following injection augmentation with calcium hydroxylapatite vocal fold filler. The reaction occurred within 30 minutes of the procedure and consisted of diffuse itching, hives, edematous face and eyelids, and voice changes indicating glottic edema. It is classified as a grade 3 systemic reaction. Consideration is given to possible etiologies and at risk patients are discussed. We recommend a postprocedure observation time of at least 30 minutes to monitor for such reactions.