First bite syndrome: our experience of laser tympanic plexus ablation

Abstract

First bite syndrome carries a high morbidity; treatment options are variable, and often unsuccessful. We describe the first documented case of laser tympanic plexus ablation, with a very effective initial response. This procedure represents a useful therapeutic option for first bite syndrome.

First bite syndrome: a complication of carotid endarterectomy

“…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. Before proceeding with pharmacological, surgical or laser ablation therapies, it is important to note that a large proportion of FBS cases are self-resolving after several months to 1 year,2–4 thus making conservative management appropriate and effective, as was the case with our patient.…”

Potential use of acupuncture in the treatment of first bite syndrome

“…The third patient noticed no improvement at all. Amin [11] recently described a case treated with laser tympanic plexus neurectomy to ablate the parasympathetic innervation to the parotid gland, therefore decreasing cross-stimulation of the sympathetic receptor and reducing over-activation of the myoepithelial cells. At three-week and two-month follow-up appointments, the patient demonstrated symptomatic resolution resulting in greater oral intake.…”

“…The pain may occasionally resolve spontaneously [8,9], nevertheless many treatment options were described over the years [10][11][12][13], none of which proved to be effective in the long-term.…”

First bite syndrome: Our experience with intraparotid injections with botulinum toxin type A

“…Radiation therapy, despite the invasiveness, has proven to have complete resolution within 1 year but is a high‐morbidity therapy . Finally, among proposed surgical treatment, tympanic neurectomy and auriculotemporal bone resection are both high risk, as they involve surgery and have not been shown to be effective …”