First Bite Syndrome Following Ipsilateral Carotid Endarterectomy

Wang, Tom Kai Ming; Bhamidipaty, Venu; MacCormick, Murray

doi:10.1177/1538574412469285

Cited by 13 publications

(16 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

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

Section: Discussionmentioning

confidence: 99%

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

show abstract

“…14 Wang et al, also published a case report of ipsilateral FBS after a carotid endarterectomy, where temporary occlusion of the ECA with a vascular clamp is an inherent, and inevitable step to the procedure of carotid endarterectomy. 7 With further documentation in the literature as well as detailed description on surgical approaches and procedures, it will be better understood which maneuver it is that causes damage to the sympathetic fibers, and learn ways in which to avoid the area to prevent this complication arising in patients, especially those with carotid bifurcations distally in the lateral neck, near the styloid process. 5 The development of the pain in FBS occurs between 5 to 7 days after the surgery.…”

Section: Discussionmentioning

confidence: 99%

“…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

“…Other surgical interventions including tympanic neuroectomy and parotid gland parasympathectomy have been shown to be unsuccessful 2–4. Intraparotid injection of botulinum toxin A (BTA) can be effective at providing temporary analgaesia and improvements in quality of life in some patient, as it blocks acetylcholine release at the neuromuscular junction, thus preventing contraction of salivary myoepithelial cells 8 13 17 18. Most recently, Amin et al 19 described the first documented use of laser tympanic plexus neurectomy for ablation of the parasympathetic innervation to the parotid gland, which demonstrated promising initial responses.…”

Section: Discussionmentioning

confidence: 99%

First bite syndrome: a complication of carotid endarterectomy

Tao

Roche-Nagle

2016

BMJ Case Reports

View full text Add to dashboard Cite

First bite syndrome (FBS) is an uncommon pain syndrome characterised by severe cramping or spasm in the parotid region with the first bite of each meal. The proposed pathogenesis is sympathetic denervation of the parotid gland secondary to iatrogenic injury with resultant cross-stimulatory parasympathetic hypersensitivity response. FBS is a potential sequela of surgeries involving the infratemporal fossa, parapharyngeal space and/or deep lobe of the parotid gland, however, only four cases of FBS secondary to carotid endarterectomy have been documented to date. We present a case and management of a 77-year-old man who developed FBS after an ipsilateral carotid endarterectomy, to raise awareness of this complication among surgeons who operate in the neck region.

show abstract

First Bite Syndrome Following Ipsilateral Carotid Endarterectomy

Cited by 13 publications

References 21 publications

First Bite Syndrome Following Rhytidectomy: A Case Report

First Bite Syndrome Following Rhytidectomy: A Case Report

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

First bite syndrome: a complication of carotid endarterectomy

Contact Info

Product

Resources

About