Case Of First Bite Syndrome Research Articles

Pain in parotid: reporting seventeen cases of first bite syndrome

Pain in parotid: reporting seventeen cases of first bite syndrome

Recipient vessel selection in the difficult neck: Outcomes of external carotid artery transposition and end-to-end microvascular anastomosis.

Selection of recipient vessels for head and neck microvascular surgery may be limited in the previously dissected or irradiated neck. When distal branches of the external carotid artery (ECA) are unavailable, additional options for arterial inflow are needed. Here we propose high ligation of the ECA and transposition toward the lower neck as an alternative. After obtaining institutional approval, patients who underwent head and neck tumor resection and simultaneous free flap reconstruction were identified over a 5-year period. Patients whose recipient artery was listed in the operative report were included. Chart review was performed to identify patient demographics, operative details, and patient and flap complications. In cases where the ECA was used, the artery was traced distally with care taken to protect the hypoglossal nerve. The ECA was then divided and transposed toward the lower neck where an end-to-end microvascular anastomosis was performed. The recipient artery used for head and neck microsurgery was available for 176 flaps, and the facial (n = 127, 72.2%) and external carotid (n = 19, 10.8%) arteries were most commonly used. There were 0 flap thromboses in the ECA group compared to 3 flap thromboses that occurred with other recipient arteries (P = 1.00). No cases of first bite syndrome or hypoglossal nerve injury were identified. The ECA may be transposed toward the lower neck and used for end-to-end microvascular anastomosis without complication of hypoglossal nerve injury or first bite syndrome. This method may be considered an alternative in patients with limited recipient vessel options for head and neck microsurgery. © 2015 Wiley Periodicals, Inc. Microsurgery 37:96-100, 2017.

First bite syndrome after bimaxillary osteotomy: case report

We present what is to the best of our knowledge the first reported case of first bite syndrome as a delayed complication of bimaxillary osteotomy.

Successful Treatment of a Case of First Bite Syndrome without Any Cause

Background: For the first bite syndrome (FBS), various causes were suggested such as parapharyngeal space surgery, resection of styloid process, carotid endarterectomy, parotid gland tumor, submandibular gland tumor, and upper cervical surgery. Actually, the real cause of FBS is still not clear. Also, suggested methods of treatment for the FBS are botulinum toxin injection, laser tympanic plexus ablation, pharmacologic approach, and no treatment. The results of those treatments were not satisfactory. Aim: The authors tried to find out the adequate method of treatment for the FBS and also tried to figure out pathologic cause of the FBS through observation of the patient response to the treatment. Case Presentation: A 38-year-old male was presented at head and neck surgery clinic with a sharp pain on the left parotid area especially at the first bite of eating food for two days. There was no cause. The patient was given trigger point injections on his left sternocleidomastoid, masseter, and temporal muscles with left mandibular nerve block five times 3 - 4 days apart. Also small amount of oral anticonvulsants were added for four weeks. Before finishing taking oral medication, the pain was gone completely. Conclusion: The authors experienced a case of FBS with no detectable cause, and treated successfully with the methods of trigger point injection, mandibular nerve block, and oral antiepileptic medication.

First bite syndrome caused by adenoid cystic carcinoma of the submandibular gland

First bite syndrome is a well-described sequelae of parapharyngeal space surgery, thought to result from sympathetic denervation of the parotid gland. We describe a case of first bite syndrome caused by an adenoid cystic carcinoma of the submandibular gland. The tumor was not clinically or radiographically apparent until 18 months after initial presentation despite repeated imaging. In patients with first bite syndrome and no surgical history, there must be high suspicion for a malignancy, which may be occult on presentation. The submandibular gland should be considered as a possible site of a lesion.

First bite syndrome: Case report of 3 patients treated with botulinum toxin and review of other treatment modalities

First bite syndrome is an unexpected yet relatively common complication of surgeries involving the parapharyngeal space. It can have a significant effect on both the quality of life and physical health of affected patients. This study presents 3 cases of first bite syndrome treated with botulinum toxin and a review of the current literature on available treatment modalities for first bite syndrome. Three patients with first bite syndrome were injected with 75 units of botulinum toxin into affected parotid glands, focusing on areas of greatest first bite pain. Two of 3 patients experienced complete relief of symptoms for 4 to 6 months. The third patient had significant decrease in pain at 4-month follow-up. Many treatments for first bite syndrome have been attempted including: dietary modification, pharmacological treatments, and surgical treatments. However, few have been successful. Botulinum toxin is a safe and effective treatment for this life altering and difficult to treat first bite syndrome.

First-Bite Syndrome Complicating Carotid Endarterectomy: A Case Report and Literature Review

First-bite syndrome (FBS) is an infrequently encountered complication of parapharyngeal space surgery. Patients experience excruciating pain in the ipsiltateral parotid gland region at the first bite of each meal, which improves with subsequent mastication. This is thought to be due to parotid gland sympathetic denervation from surgery with resultant hypersensitivity to parasympathetic impulses. There is no consensus on best treatment for FBS although symptoms tend to improve with time. There are only 2 case reports linking carotid endarterectomy and FBS so far. We report the third case of FBS after carotid endarterectomy to raise awareness among vascular surgeons of the possibility of this complication.

First-bite syndrome: A review of 29 patients with parapharyngeal space tumor

Objective The aim of this study is to clarify the etiology of first-bite syndrome. Methods A total of 29 consecutive patients treated with a surgical resection for parapharyngeal space tumor between April 1999 and April 2005 were retrospectively reviewed. Results Nine cases of first-bite syndrome were developed. Eight of those patients had undergone surgical ablation of the cervical sympathetic chain and/or external carotid artery. In two patients who underwent ablation of the sympathetic chain but in whom first-bite syndrome did not develop, the superior cervical ganglion was probably preserved. Conclusion The present findings strongly indicate that loss of sympathetic innervation to the parotid gland from the superior cervical ganglion causes first-bite syndrome. They also suggest that some residual or autonomous activity of the superior cervical ganglion could prevent development of first-bite syndrome even if the lower sympathetic trunk was ablated.

Ｆｉｒｓｔ Ｂｉｔｅ Ｓｙｎｄｒｏｍｅ２症例と発症機序

Two cases of first bite syndrome (FBS) were reported as a complication after surgery for parapharyngeal tumor. FBS is the development of pain in the parotid area associated with the first bite of food, especially the first meal of the day. In one case, pleomorphic adenoma of the left parotid gland extended into the parapharyngeal space. During resection, dissection around the external carotid artery was performed to mobilize the parotid tail and part of the parotid gland tissue was preserved. In the other case, acinic cell carcinoma of the left parapahryngeal space was resected. During resection, the external carotid artery was cut and most of the parotid gland was preserved. In both cases, sympathetic innervation of the parotid gland through the sympathetic plexus around the external carotid artery was lost without Homer's syndrome. It is possible that sympathectomy of the residual parotid gland is responsible for the development of FBS.

副咽頭間隙腫瘍の検討

Tumors arising in the parapharyngeal space are rare. We reviewed 13 cases of parapharyngral space tumors that had been operated on between 1999 and 2004, and investigated the preoperative diagnosis, method of operation, and complications after surgery. Computed tomography, magnetic resonance imaging and fine-needle aspiration cytology were very useful for preoperative diagnosis, judging the extent of involvement and localization, and assessing the pathology of the tumor in the parapharyngeal space. The pathological diagnosis of these tumors was pleomorphic adenoma (6 cases), neurilemmoma (5 cases), ganglioneuroma (1 case), and malignant pleomorphic adenoma (1 case). The cervical approach was the most common, and was used in seven cases. Other surgical approaches included the cervical approach with mandibulotomy (2 cases), cervical-parotid approach (2 cases), and parotid approach (2 cases). First bite syndrome (FBS) has recently been reported as a complication after surgical removal of parapharyngeal space tumors. We experienced 4 cases of FBS. Since FBS was very difficult to treat in these patients, it is necessary to be aware of this syndrome.