First Bite Syndrome as a Presenting Symptom of Parapharyngeal Space Malignancy

Abstract

Background. First bite syndrome is a known complication after parapharyngeal space surgery. This syndrome is usually encountered when the surgery is extensive but the parotid gland is preserved. A disruption in the balance between sympathetic and parasympathetic innervation to the parotid gland has been posited to play a role.Methods. We report a 74-year-old woman with a parapharyngeal space malignancy who presented with first bite syndrome prior to any surgical intervention. The tumor and left parotid gland were resected via a transcervical approach. During the operation, the sympathetic chain was found to be directly involved with the tumor.Results. The patient reported complete resolution of first bite syndrome immediately after the operation, and remained free of this symptom at 6 months' follow-up.

Potential use of acupuncture in the treatment of first bite syndrome

“…FBS usually presents as a complication after upper cervical surgery, even though some authors described sporadic cases where FBS occurred as a presenting symptom of some parapharyngeal space tumors [5][6][7]. In the absence of animal studies the pathogenesis remains uncertain.…”

“…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. Moreover, Deganello [5] and other authors from then on [6,7], described FBS as a presenting symptom of parapharyngeal space tumors. …”

Pre-operative Occurrence of First Bite Syndrome in Two Cases of Parotid Gland Tumour

“…However, in recent years, few pre-operative cases without a history of trauma have also been reported. [6][7][8][9] The pathophysiology of FBS is unknown. The most widely accepted theory suggests that FBS takes place secondary to the damage of the cervical sympathetic trunk or the postganglionic sympathetic efferent fibres which innervate the parotid gland.…”

“…These have been associated with the presence of tumours in the parotid or submandibular glands or parapharyngeal region. [6][7][8][9] Salivary gland tumours constitute about 5-6% of head-and-neck cancers. [10] The prevalence and incidence of salivary gland tumours are 4.7 and 0.9 cases/100,000 individuals, respectively.…”

Chronic atypical first bite syndrome and primary squamous cell carcinoma of the parotid

“…The severity of pain varies and has the potential to severely affect the patient's quality of life. The syndrome is classically described as a postoperative complication of parapharyngeal space surgery, and is believed to be secondary to disruption of the sympathetic plexus along the carotid system during surgery . The pain generally first presents 1 week after surgery and may require surgical or medical intervention (anticonvulsants and tricyclic antidepressants) or other methods, such as Botox, for the cyclic prandial pain, with the possibility of an incurable state of disease …”