First bite syndrome: a complication of carotid endarterectomy

Tao, Mary Jiayi; Roche-Nagle, Graham

doi:10.1136/bcr-2015-213996

Cited by 10 publications

(16 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If a tumor could not be found, close follow-up and repeated imaging are warranted because tumors might become visible after several months. 22 The present case illustrates primary FBS caused by nonspecific adenocarcinoma in the deep lobe of the parotid gland. After surgical treatment, the symptoms of primary FBS were completely relieved.…”

Section: Discussionmentioning

confidence: 76%

Primary First Bite Syndrome of the Parotid Gland: Case Report and Literature Review

Yang

Wang

et al. 2020

Ear Nose Throat J

View full text Add to dashboard Cite

Objective: A case of primary first bite syndrome (FBS), diagnosed in a patient with nonspecific adenocarcinoma of the deep lobe of the parotid gland. Data Sources: A Medline literature search was conducted on PubMed, using the keywords “first bite syndrome.” Review Methods: Using primary FBS and existence of a definite etiology as inclusion criteria. Results: We report on an unusual case of primary FBS, which had no surgical history. After multiple examinations, the pain was localized to a mass in the deep lobe of the parotid gland. After tumorectomy, the FBS pain was significantly relieved. The postoperative pathological examination determined that the excised mass was a nonspecific adenocarcinoma. Reviewing the literature, we found that primary FBS was mostly caused by malignant tumors in the inferior temporal fossa, the deep lobe of the parotid gland, and (or) the parapharyngeal space. Surgery was reported to be an effective treatment. Conclusion: The case highlights the critical importance of identifying the etiology of primary FBS. When manifested with a primary FBS, malignant tumors must be high on the differential diagnosis list, especially those in the region of the inferior temporal fossa, the deep lobe of the parotid gland, and the parapharyngeal space.

show abstract

Section: Discussionmentioning

confidence: 76%

Primary First Bite Syndrome of the Parotid Gland: Case Report and Literature Review

Yang

Wang

et al. 2020

Ear Nose Throat J

View full text Add to dashboard Cite

show abstract

“…This results in a cross-stimulatory parasympathetic secretory hyperactivity response. 13 This supramaximal contraction of the parotid myoepithelial cells upon the first bite causes the head and neck pain and cramps experienced by patients. 17 However, this pathophysiologic mechanism of FBS has not been definitively demonstrated.…”

Section: Discussionmentioning

confidence: 99%

“…Aside from parotid surgery alone, reports of FBS have been related to a variety of upper cervical surgeries, to include procedures in the infratemporal fossa and parapharyngeal space, carotid endarterectomy, and temporomandibular joint replacement. 13,18-22 It has also been encountered after non-invasive treatments including chemotherapy and radiotherapy. 23-24 Some have reported FBS developing in the absence of any inciting factor or history of head and neck surgery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

First Bite Syndrome Following Rhytidectomy: A Case Report

Gunter

Llewellyn

Perez

et al. 2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

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.

show abstract

“…5 The association of FBS as a complication of CEA was first alluded in a study in 1986 by Haubruch, 2 and similarly a gustatory pain as a result of CEA was first mentioned by Truax, BT, 6 but to this day there are limited cases reported on the prevalence of FBS in patients who have undergone CEA. 1,[6][7][8][9] The aim of this case report is to present a patient who developed FBS as a complication of a right CEA including the progression of their symptomatology. We then include a brief review of the literature and discuss strategies to further inform the vascular surgery community on this uncommon complication.…”

Section: Introductionmentioning

confidence: 99%

First Bite Syndrome: Presentation of a Patient Status-Post Right Carotid Endarterectomy

Charles-Harris

Rodriguez

2020

Vasc Endovascular Surg

View full text Add to dashboard Cite

First bite syndrome (FBS) is a sharp unilateral pain in the vicinity of the angle of the mandible after taking the first bite of a meal that presents typically after surgery in the area of the ipsilateral parapharyngeal space. It is not confirmed what the pathophysiology is that causes this pain, but the proposed mechanism is the iatrogenic damage of sympathetic fibers that extend from the superior cervical ganglion (SCG) to innervate the parotid gland. The presentation of this syndrome has been acknowledged in patients who have undergone head and neck tumor resections, but it has not been documented in the same thorough manner among vascular surgery cases in the parapharyngeal space, possibly because of a higher risk of development in other head and neck surgeries, or to under-reporting of cases. To date, only 5 cases of FBS status post carotid endarterectomy have been documented in the literature. Definitive treatment of FBS has not been established. Some studies have shown improvement with amitriptyline, and carbamazepine as well as botulinum toxin injections. We will present the case of a 75 year old male who developed first bite syndrome after a right carotid endarterectomy with efforts of raising awareness of a potential acute complication of carotid endarterectomy.

show abstract

First bite syndrome: a complication of carotid endarterectomy

Cited by 10 publications

References 19 publications

Primary First Bite Syndrome of the Parotid Gland: Case Report and Literature Review

Primary First Bite Syndrome of the Parotid Gland: Case Report and Literature Review

First Bite Syndrome Following Rhytidectomy: A Case Report

First Bite Syndrome: Presentation of a Patient Status-Post Right Carotid Endarterectomy

Contact Info

Product

Resources

About