First-Bite syndrome and Eagle syndrome

Abstract

Introduction: Eagle Syndrome (ES) is caused by the ossification/calcification of the stylohyoid ligament and is associated with many different symptoms such as otalgia, restricted mouth opening, or an intrapharyngeal foreign body sensation. First-bite syndrome (FBS) is characterized by pain in the parotid and retromandibular region, when taking the first bite in a meal and occurs more or less invariably. Observation: A 50-year-old female patient presented complaining of right retromandibular pain, that irradiated to the right side of the mandible and right shoulder, only when eating for the first time a day and at the first bite. Medical history and clinical examination did not reveal any signs of cervical surgery or cervical trauma. Palpation was painful at a specific point in right retromandibular point region, the rest of the intraoral and extraoral examinations were normal. The right and left condylar x-rays (open mouth and closed mouth) revealed an elongation of both the right and left stylohyoid ligaments. Discussion: Usually, FBS occurs after cervical surgery, for example after resection of the stylohyoid ligament for ES. Our case report shows, on the contrary, FBS that was associated with ES. The pathophysiological explanation of FBS depends on an irritative or traumatic factor in the sympathetic nerve fibers of the parotid gland. Conclusion: This association allows us to present both syndromes and to carry out an up to date pathophysiological examination and therapeutic proposals concerning FBS.