First Bite Syndrome
First bite syndrome (FBS) is characterized by severe, sharp, or cramping pain in the parotid region that occurs with the first bite of each meal and improves with subsequent bites. The pathophysiology is thought to involve an imbalance between sympathetic and parasympathetic innervation of the parotid gland, often due to surgical interventions in the parapharyngeal space, parotid gland, or upper cervical region.[1][2][3]
FBS is most commonly seen following surgeries such as parotid gland resection, parapharyngeal space dissection, and cervical sympathetic chain injury. It can also occur idiopathically or in association with neoplastic conditions. The pain is typically triggered by the initial taste stimulus and subsides with continued mastication.
Treatment options for FBS are limited and primarily based on case reports and series. Symptomatic management may include botulinum toxin injections, which have shown efficacy in some cases[4][5], and neuropathic pain medications such as anticonvulsants or tricyclic antidepressants. In some instances, patients may experience spontaneous resolution of symptoms over time.
Resources
References
- ā Steel, Stephanie J.; Robertson, Carrie E. (2021-05). "First Bite Syndrome: What Neurologists Need to Know". Current Pain and Headache Reports (in English). 25 (5): 31. doi:10.1007/s11916-021-00950-7. ISSN 1531-3433. Check date values in:
|date=(help) - ā Handa, Shruti; Shafik, Adam A.; Intini, Rossella; Keith, David A. (2022-03). "First Bite Syndrome ā An Underrecognized and Underdiagnosed Pain Complication After Temporomandibular Joint Surgery". Journal of Oral and Maxillofacial Surgery (in English). 80 (3): 437ā442. doi:10.1016/j.joms.2021.10.012. Check date values in:
|date=(help) - ā Linkov, Gary; Morris, Luc G. T.; Shah, Jatin P.; Kraus, Dennis H. (2012-08). "First bite syndrome: Incidence, risk factors, treatment, and outcomes". The Laryngoscope (in English). 122 (8): 1773ā1778. doi:10.1002/lary.23372. ISSN 0023-852X. Check date values in:
|date=(help) - ā Bromberg, Hannah; Ibanez, Jessica (2024-11-01). "Use of Botulinum Toxin for Effective Management of First Bite Syndrome Secondary to Malignancy: A Case Report". Journal of Palliative Medicine (in English). 27 (11): 1559ā1561. doi:10.1089/jpm.2024.0081. ISSN 1096-6218.
- ā Ghosh, Ankona; Mirza, Natasha (2016-01). "First bite syndrome: Our experience with intraparotid injections with botulinum toxin type A". The Laryngoscope (in English). 126 (1): 104ā107. doi:10.1002/lary.25571. ISSN 0023-852X. Check date values in:
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