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.

A case of idiopathic First Bite Syndrome responding to carbamazepine

“…Following surgery it usually takes a few weeks but can sometimes take several months for symptoms to develop. In addition, there has been one recent case of Eagle's syndrome presenting with symptoms of FBS pre‐operatively …”

“…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.…”