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

Masood, Maheer M.; Giosia, Massimiliano Di; Hackman, Trevor

doi:10.1002/hed.25321

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…17 However, patients presenting preoperatively with FBS secondary to malignancy within the parotid gland or parapharyngeal space classically report improvement of symptoms following therapeutic surgery with adjuvant radiation as indicated. 38,39,42,44,51 Oral medications such as anticonvulsants (gabapentin, carbamazepine) used alone or in conjunction with antidepressants (amitriptyline) have variable outcomes in terms of modulating the pain associated with FBS, but these medications are known to have significant side effect profiles. 14-15,31…”

Section: Discussionmentioning

confidence: 99%

First Bite Syndrome Following Rhytidectomy: A Case Report

Gunter

Llewellyn

Perez

et al. 2020

Ann Otol Rhinol Laryngol

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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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Section: Discussionmentioning

confidence: 99%

First Bite Syndrome Following Rhytidectomy: A Case Report

Gunter

Llewellyn

Perez

et al. 2020

Ann Otol Rhinol Laryngol

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“…More recently Maheer et al . described a male, with no surgical history, diagnosed with FBS 9 years previously who had a CT scan 6 years later which revealed a mass consistent with a lipoma in the right parotid region. After no improvement in pain with various drugs and an enlarging mass on the right face he was diagnosed with a squamous cell carcinoma of the parotid.…”

Section: Introductionmentioning

confidence: 97%

“…In addition, there has been one recent case of Eagle's syndrome presenting with symptoms of FBS pre-operatively. 13 Tumours reported to have caused symptoms of FBS include tumours of the PPS (synovial sarcoma) 14 , deep poles of the parotid (adenoid cystic carcinoma, squamous cell carcinoma and mucoepidermoid carcinoma) [15][16][17] , and submandibular gland (adenoid cystic carcinoma) 18 . Caution must therefore be exercised with patients experiencing symptoms of FBS.…”

Section: Introductionmentioning

confidence: 99%

“…Guss et al reported an adenoid cystic carcinoma of the submandibular gland which was not clinically or radiographically apparent until 18 months after initial presentation of FBS symptoms 18 . More recently Maheer et al described a male, with no surgical history, diagnosed with FBS 9 years previously who had a CT scan 6 years later which revealed a mass consistent with a lipoma in the right parotid region 16 . After no improvement in pain with various drugs and an enlarging mass on the right face he was diagnosed with a squamous cell carcinoma of the parotid.…”

Section: Introductionmentioning

confidence: 99%

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A case of idiopathic First Bite Syndrome responding to carbamazepine

Wemyss¹,

Gibson

Ryan³

2019

Oral Surgery

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First Bite Syndrome (FBS) is a painful condition which classically presents as severe pain in the pre‐auricular region, initiated on the first bite of a meal. It is usually associated with a history of upper neck surgery or tumour of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises from damage to, or resection of, the cervical sympathetic trunk resulting in loss of sympathetic innervation to the parotid salivary gland. Idiopathic FBS has been reported only a handful of times in the literature. We present the case of a 51‐year‐old male, urgently referred to the Department of Oral Medicine, with a 3‐week history of severe, sharp, unilateral pain from the right angle of mandible, intensity described as ‘20/10', occurring only on the first bite of eating. This would diminish over 2 min. Clinical examination revealed tenderness over the right condylar neck and angle of mandible only. FBS was suspected and the patient immediately started on carbamazepine. An urgent MRI displayed no abnormalities of the temporomandibular joints, PPS, trigeminal nerve or parotid gland. Restorative Dentistry review confirmed no odontogenic or occlusal cause and on review, 4 months later the patient reported complete resolution of symptoms on 200 mg of carbamazepine three times daily. This case highlights the importance of taking a thorough pain history. Patients with symptoms of FBS and no history of surgery to the neck should have an MRI to rule out parotid gland or PPS tumour. Carbamazepine can be successful in treating idiopathic FBS and can resolve symptoms completely.

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“…GLOSSARY FBS = first bite syndrome; RFA = radiofrequency thermal nerve ablation; TN = trigeminal neuropathy F irst bite syndrome (FBS) is an intense unilateral facial pain around the parotid gland region that occurs at the first bite (or by salivation) of each meal, which improves with continued chewing. [1][2][3][4][5][6] FBS is a complication of surgery or a mass in the infratemporal fossa, parotid gland, or near the ipsilateral cervical sympathetic trunk. 2,4 FBS pathophysiology is thought to be sympathetic denervation of the myoepithelial cells of the parotid gland, which leads to a parasympathetic hyperactivation and supermaximal gland contraction.…”

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confidence: 99%

First Bite Syndrome Relief With Trigeminal Nerve Branch Block and Ablation: A Case Report

et al. 2020

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First bite syndrome (FBS) is intense facial pain at the first bite of each meal. Currently, no guidelines exist for treating FBS, although botulinum toxin injection has shown benefit. We describe a case of right-sided FBS and painful trigeminal neuropathy, in which FBS resolved for 2 weeks using maxillary and mandibular nerve block and radiofrequency nerve thermal ablation (RFA). Our treatment may have disrupted somatic sensory input from the parotid carried by the auriculotemporal nerve or lesioned the otic ganglion resulting in decreased parasympathetic hyperactivation. Further studies are warranted to evaluate the use of this procedure for FBS.

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

Cited by 10 publications

References 19 publications

First Bite Syndrome Following Rhytidectomy: A Case Report

First Bite Syndrome Following Rhytidectomy: A Case Report

A case of idiopathic First Bite Syndrome responding to carbamazepine

First Bite Syndrome Relief With Trigeminal Nerve Branch Block and Ablation: A Case Report

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