First bite syndrome (FBS) is a sharp unilateral pain in the vicinity of the angle of the mandible after taking the first bite of a meal that presents typically after surgery in the area of the ipsilateral parapharyngeal space. It is not confirmed what the pathophysiology is that causes this pain, but the proposed mechanism is the iatrogenic damage of sympathetic fibers that extend from the superior cervical ganglion (SCG) to innervate the parotid gland. The presentation of this syndrome has been acknowledged in patients who have undergone head and neck tumor resections, but it has not been documented in the same thorough manner among vascular surgery cases in the parapharyngeal space, possibly because of a higher risk of development in other head and neck surgeries, or to under-reporting of cases. To date, only 5 cases of FBS status post carotid endarterectomy have been documented in the literature. Definitive treatment of FBS has not been established. Some studies have shown improvement with amitriptyline, and carbamazepine as well as botulinum toxin injections. We will present the case of a 75 year old male who developed first bite syndrome after a right carotid endarterectomy with efforts of raising awareness of a potential acute complication of carotid endarterectomy.

Background Anterior tibial artery pseudoaneurysm is a very uncommon complication after orthopedic surgery and trauma. A combined treatment modality using thrombin injection, coil embolization, and surgical approach is described and currently being evaluated compared with other treatment modalities. Patient Description This study reports the case of a 33-year-old man who presented in the office with a pulsatile mass just below the right knee. The patient with a history of trauma to his right leg during a motor vehicle accident underwent open reduction internal fixation of a proximal tibia-fibula fracture. Eight weeks later the patient had a pulsatile mass in the surgical area. A venous Doppler ultrasound was initially performed in the emergency room which revealed an incidental finding of a 5.60 cm × 3.54 cm pseudoaneurysm. Methods As modalities of treatment the patient had coil embolization as well as two separate sessions of thrombin injection with poor response. Finally, he underwent repair of the right anterior tibial artery pseudoaneurysm with a vein patch, which was successful. This case highlights different modalities that have been used to treat anterior tibial artery pseudoaneurysms. Conclusion Based on previous reported cases and our own case, we concluded that surgical approach is the most successful modality of treatment for proximal anterior tibial artery pseudoaneurysms.

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