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Barati B, Ghazizadeh M, Shahzamani A. Successful management of an idiopathic first bite syndrome: A case report and review. Clin Case Rep 2024; 12:e8880. [PMID: 38725934 PMCID: PMC11079535 DOI: 10.1002/ccr3.8880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/28/2024] [Accepted: 04/13/2024] [Indexed: 05/12/2024] Open
Abstract
FBS is associated with surgical interventions or malignancies and could occur idiopathically. Also, this case highlights the successful management of FBS symptoms with pharmacological intervention with gabapentin and carbamazepine.
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Affiliation(s)
- Behrouz Barati
- Department of Otorhinolaryngology, Head and Neck Surgery, Taleghani HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Matin Ghazizadeh
- Department of Otorhinolaryngology, Head and Neck Surgery, Taleghani HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Arvin Shahzamani
- Department of Otorhinolaryngology, Head and Neck Surgery, Taleghani HospitalShahid Beheshti University of Medical SciencesTehranIran
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Saleem MI, Bhuiya S, Tham T, Georgolios A. Idiopathic parotid pain: a rare clinical presentation of first bite syndrome without history of head and neck surgery or underlying malignancies. J Surg Case Rep 2022; 2022:rjac566. [PMID: 36540302 PMCID: PMC9760012 DOI: 10.1093/jscr/rjac566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022] Open
Abstract
First bite syndrome (FBS) has been previously characterised as a surgical complication, following head and neck surgical procedures. There are also rare reports in the literature associating FBS with malignancies of the head and neck. The term 'idiopathic parotid pain' (IPP) has been used recently to describe an exceedingly rare clinical presentation similar to FBS, but without history of head and neck surgery or malignancy. We present the rare case of a 65-year-old male diagnosed with IPP, our work-up and management.
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Affiliation(s)
- Matthew I Saleem
- Correspondence address. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY 11549, USA.Tel: 516-463-7516; E-mail:
| | - Sabreen Bhuiya
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY 11549, USA
| | - Tristan Tham
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY 11549, USA
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Handa S, Shafik AA, Intini R, Keith DA. FIRST BITE SYNDROME - An Underrecognized and Underdiagnosed Pain Complication After Temporomandibular Joint Surgery. J Oral Maxillofac Surg 2021; 80:437-442. [PMID: 34838508 DOI: 10.1016/j.joms.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE First bite syndrome (FBS) can develop after head and neck surgical procedures. The aim of this study is to identify patients diagnosed with FSB after temporomandibular joint (TMJ) surgery, including their pain characteristics and risk factors for FBS. METHODS Using a retrospective study design, a cohort of 24 patients with confirmed diagnosis of FBS were identified from the oral and maxillofacial surgery and orofacial pain (OFP) practices at Massachusetts General Hospital and Research Patient Data Registry (RPDR) between 1975 and 2019. The inclusion criteria were facial pain that was triggered by taste stimulus only and followed by a refractory period until the next gustatory stimulus. RESULTS Of the 24 patients identified, 19 had undergone TMJ surgery, 3 patients had idiopathic FBS, 1 had a parapharyngeal space tumor and 1 developed FBS after facial burns. In the surgical patients, the median duration of onset was 2.75 months post-surgery. Most patients reported pain in the parotid region. Pain was only triggered by a taste stimulus and subsided with subsequent bites of food. 2 patients underwent spontaneous resolution of their symptoms and 1 reported complete resolution with onabotulinum toxin A (BTX) injections. Anxiety and depression were the most common comorbid conditions. CONCLUSION FBS is an underrecognized pain complication in TMJ surgery patients. A precise history and accurate description of the pain is necessary for correct diagnosis which is important for improved treatment outcomes.
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Affiliation(s)
- Shruti Handa
- Instructor, Orofacial Pain, Division of Oral and Maxillofacial Surgery, Department of Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
| | - Adam A Shafik
- Instructor, Orofacial Pain, Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, CA
| | - Rossella Intini
- Visiting Oral and Maxillofacial Surgeon, Division of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Professor, Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA
| | - David A Keith
- Visiting Oral and Maxillofacial Surgeon, Division of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Professor, Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA
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Abstract
PURPOSE OF REVIEW Though first bite syndrome is well known in surgical settings, it is not commonly included in the differential for sharp paroxysmal facial pain in the neurology literature. This paper will highlight the clinical features and relevant anatomy of first bite syndrome, with the goal of helping clinicians differentiate this from other similar facial pain disorders. RECENT FINDINGS First bite syndrome is severe sharp or cramping pain in the parotid region occurring with the first bite of each meal and improving with subsequent bites. Pathophysiology has been attributed to imbalanced sympathetic/parasympathetic innervation of the parotid gland. This is seen most typically in the post-surgical setting following surgery in the parotid or parapharyngeal region, but neoplastic etiologies have also been reported. It is common for patients to present with concurrent great auricular neuropathy and/or Horner's syndrome. Evidence regarding treatment is limited to case reports/series, however, botulinum toxin injections and neuropathic medicines have been helpful in select cases. It is critical for clinicians to be able to differentiate first bite syndrome from other paroxysmal facial pain. To help with this, we have proposed diagnostic criteria for clinical assessment. Patients often improve gradually over time, but symptomatic treatment with botulinum toxin or neuropathic medicine may be required.
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Clinical and Pain-Related Characteristics of Idiopathic First Bite Syndrome Induced by Taste in Japanese Patients without Diabetes: A Retrospective Study of Five Cases. Pain Res Manag 2021; 2021:6674102. [PMID: 33628354 PMCID: PMC7896861 DOI: 10.1155/2021/6674102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/22/2021] [Indexed: 11/17/2022]
Abstract
Objective First bite syndrome (FBS) is a condition in which the first bite of each meal causes parotid pain. Etiologies of FBS include prior surgery of the upper cervical region and, rarely, head and neck tumors. Idiopathic FBS rarely presents in patients without a history of surgery or evidence of an underlying tumor. Idiopathic FBS may be categorized into two subtypes: that in patients with diabetes and that in patients without diabetes. Idiopathic FBS in patients without diabetes may be overlooked or misdiagnosed because the condition has been described only in a few case reports. We aimed to identify the clinical and pain-related characteristics of idiopathic FBS in patients without diabetes. Methods We retrospectively analyzed the clinical data of five patients without diabetes who were diagnosed with idiopathic FBS in our department between January 2010 and December 2016. Results Four of the five patients were female, and the overall median age was 52 years (range: 13–61). All patients immediately experienced parotid pain upon tasting food without chewing. Addition of an acidic solution to the ipsilateral posterior third of the tongue evoked parotid pain. The median degree of pain intensity and interference with eating due to pain was 9 (range: 3–10) and 9 (range: 5–10) on a numerical rating scale of 0–10, respectively. Idiopathic FBS was bilateral in two patients. Two patients had tenderness on mild pressure over the affected parotid region. Two patients presented with ipsilateral idiopathic Horner's syndrome. Conclusions Our findings indicate that the characteristics of idiopathic FBS in patients without diabetes are largely consistent with those previously reported in postoperative FBS, supporting the notion that idiopathic FBS is a subtype of FBS. Thus, it is necessary to consider idiopathic FBS during the evaluation of facial pain triggered at the beginning of a meal.
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Nayak RS, Rakendu S, Kotrashetti VS, Nayak R. Idiopathic first bite syndrome - A rare case report with review of literature. J Oral Maxillofac Pathol 2020; 24:403. [PMID: 33456263 PMCID: PMC7802840 DOI: 10.4103/jomfp.jomfp_46_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/06/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022] Open
Abstract
First bite syndrome (FBS) is a condition that classically presents as severe pain in the preauricular region, initiated on the first bite of a meal. In most of the cases reported, it is associated with a history of upper neck surgery or tumor of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises due to damage to the cervical sympathetic trunk leading to the loss of sympathetic innervations to the parotid salivary gland. Literature also showed occurrence of this syndrome in individuals who had no history of parotid tumor, PPS tumor or surgery of the upper neck, and such cases are referred to as idiopathic FBS (IFBS). There are very few case reports reported on IFBS. We report the one such rare case of IFBS in a 35-year-old male, referred to the outpatient department, with a 5-month history of severe, sharp pain and bilateral swelling in the parotid region occurring only on the first bite of eating and would diminish over few minutes.
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Affiliation(s)
- Ramakant S Nayak
- Department of Oral Pathology and Microbiology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | - S Rakendu
- Department of Oral Pathology and Microbiology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | - Vijayalakshmi S Kotrashetti
- Department of Oral Pathology and Microbiology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | - Ranganath Nayak
- Department of Oral and Maxillofacial Surgery, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
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Gunter AE, Llewellyn CM, Perez PB, Hohman MH, Roofe SB. First Bite Syndrome Following Rhytidectomy: A Case Report. Ann Otol Rhinol Laryngol 2020; 130:92-97. [DOI: 10.1177/0003489420936713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: First bite syndrome (FBS) is a known complication of parotid gland resection, parapharyngeal space dissection, and cervical sympathetic chain injury. It can be described as severe cramping or spasms in the parotid region triggered by the first bite of a meal, with the pain lessening during each subsequent bite. Although dissection for a rhytidectomy is in the vicinity of the parotid parenchyma, face-lift is not typically characterized as a procedure that can lead to FBS. Case description: A 53-year-old female underwent a deep plane face-lift to address her goals of improving jowls, nasolabial folds, and cervicomental angle. Intraoperatively, the dissection proceeded without any complications. Initially, her postoperative course was uneventful; 3 weeks after surgery, she noticed pain at the start of mastication that would improve throughout the course of a meal. She elected to proceed with observation. At 6 months after surgery, she began to experience improvement in her symptoms, and shortly thereafter had complete resolution. Discussion: First bite syndrome is a complication associated with deep lobe parotid resection, first described in 1998. The innervation of the parotid gland is complex and includes contributions from the auriculotemporal nerve, the great auricular nerve, and the cervical sympathetic chain. During rhytidectomy, dissection occurs along the parotidomasseteric fascia in order to elevate a flap of the superficial musculoaponeurotic system. Inadvertent injury to the parotid parenchyma can lead to damage to the postganglionic sympathetic fibers innervating the myoepithelial cells. Ultimately, expectant management is the mainstay of treatment and symptoms typically resolve within 6 months to 1 year. Conclusion: First bite syndrome is a complication that can be seen with a variety of facial surgeries. In the case of rhytidectomy, FBS should be considered a potential risk, as dissection into the parenchyma of the parotid gland can result in postoperative autonomic dysfunction.
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Affiliation(s)
- Anne E. Gunter
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Charles M. Llewellyn
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Paloma B. Perez
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Marc H. Hohman
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Scott B. Roofe
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Abstract
The First Bite Syndrome is a rare late (1-2 months) post operation complication of surgery in the infratemporal fossa, parapharyngeal space and especially involving the deep lobe of parotid gland. Sometimes it can significantly worsen the patient's quality of life. Acute, sudden, short time pain in the parotid gland region with irradiation to the ear during the first bite a meal is a characteristic for this syndrome. The correct diagnosis and individual approach in choosing a treatment method is the key to success in treating this complication. The purpose of our article is to supplement scanty data on this complication in Polish literature.
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Affiliation(s)
| | - Andrzej Skorek
- Katedra i Klinika Otolaryngologii, Gdański Uniwersytet Medyczny
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Hayashi K, Onda T, Ogane S, Kamio T, Ohata H, Takano N, Shibahara T. Idiopathic first bite syndrome treated with Rikkosan: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2019. [DOI: 10.1016/j.ajoms.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Masood MM, Giosia MD, Hackman TG. Chronic atypical first bite syndrome and primary squamous cell carcinoma of the parotid. Head Neck 2018; 40:E82-E86. [PMID: 29927014 DOI: 10.1002/hed.25321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/08/2018] [Accepted: 04/09/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND First bite syndrome is a well-recognized complication of parapharyngeal space surgery. There are no reported cases of protracted first bite syndrome and subsequent diagnosis of a primary squamous cell carcinoma (SCC) of the parotid. METHODS We present the case of a 73-year-old man with no surgical history and 9 years of first bite syndrome who was ultimately diagnosed with a primary SCC of the parotid. Diagnostic workup, including MRI and biopsy, along with oncologic treatment, were performed. RESULTS Surgical treatment confirmed malignancy and also resulted in complete resolution of the first bite syndrome. CONCLUSION First bite syndrome without prior surgery may warrant further diagnostic workup with imaging to evaluate for salivary gland pathology. When no radiographic mass lesion is detected but the patient displays protracted symptoms unresponsive to conservative therapy, one should maintain an index of suspicion for malignancy, especially in the presence of symptom escalation.
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Affiliation(s)
- Maheer M Masood
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Massimiliano Di Giosia
- Orofacial Pain Clinic-Department of Endodontics, University of North Carolina School of Dentistry, Chapel Hill, North Carolina
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Clinical Features of Idiopathic Parotid Pain Triggered by the First Bite in Japanese Patients with Type 2 Diabetes: A Case Study of Nine Patients. PAIN RESEARCH AND TREATMENT 2018; 2018:7861451. [PMID: 29796314 PMCID: PMC5896206 DOI: 10.1155/2018/7861451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/25/2018] [Indexed: 12/05/2022]
Abstract
Objective First bite syndrome, characterized by pain in the parotid region after the first bite of each meal, predominantly develops in patients who have had head and neck surgery. Idiopathic parotid pain (IPP) that mimics first bite syndrome may present in patients without a history of surgery or evidence of an underlying tumor, but its clinical features are unclear. This study characterized the clinical characteristics of IPP in patients with diabetes. Study Design A retrospective case review involving the clinical findings and pain characteristics of nine patients with IPP and diabetes who presented to our department between 2013 and 2016. Results All the patients were men diagnosed with type 2 diabetes (median age, 43 years). IPP developed unilaterally in seven patients and bilaterally in two. The median intensity of the first bite pain was 8 on a numerical rating scale of 0–10. The trigger factor was gustatory stimuli, and the trigger area was the posterior section of the tongue. Postprandial pain occurred within 1–10 min after meals in six patients. Conclusions IPP may be considered a separate disorder, in which the pain characteristics are similar to those of first bite syndrome but the clinical features and pathophysiology are different.
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