First bite syndrome: A complication of surgery involving the parapharyngeal space

Abstract

Preservation of parotid gland tissue and a loss of its sympathetic nerve supply, whether by disruption of the cervical sympathetic chain as evidenced by a Horner's syndrome or more selective denervation by ligation of the external carotid artery with its accompanying sympathetic nerve plexus, were common features of all patients. This series supports the concept of parotid "sympathectomy" as an etiologic factor in FBS.

First bite syndrome as presenting symptom of parapharyngeal adenoid cystic carcinoma

“…2 First bite syndrome has previously been described only as a complication of parapharyngeal space surgery. [3][4][5][6] The main symptom is pain in the parotid and jaw, often with radiation to the ear, which lasts a few seconds and occurs with the first bite of each meal. 3 The symptoms are always worse with the first bite, and improve and resolve with subsequent bites, only to recur at the start of the next meal.…”

Pharmacological treatment of a patient with first‐bite syndrome

“…A previous study also demonstrated that intrathecal fentanyl did not reduce the risk of postdural puncture headache with a 25G Quincke needle [2]. In addition to Al-metwalli's study there have been other reports of epidural morphine preventing headache after accidental dural puncture [3,4]. I have however, been unable to find any references to the effect of intrathecal diamorphine on the incidence of postdural puncture headache following spinal anaesthesia.…”

Potential use of acupuncture in the treatment of first bite syndrome

“…Some evidences are in favor of this pathogenetic hypothesis. In fact, previous studies [2,3] described FBS to occur together with Horner's syndrome. Chiu [2] reported nine cases of FBS in a series of 12 patients undergoing resection of the cervical sympathetic trunk or presenting loss of sympathetic function documented by Horner's syndrome.…”

“…Following this publication, several papers concerning FBS were published [2][3][4] and different clinical variants were reported. More than 95% of published cases correspond to postoperative syndromes following upper neck surgery, such as resection of mixed and/or cervical sympathetic nerve tumors, deep cervical lymph node dissection, parotid gland surgery, particularly involving its deep lobe, parapharyngeal and infratemporal fossa surgery, carotid bifurcation and/or internal carotid artery surgery, and resection of the styloid process.…”