First Bite Syndrome: What Neurologists Need to Know

Steel, Stephanie J.; Robertson, Carrie E.

doi:10.1007/s11916-021-00950-7

Cited by 12 publications

(19 citation statements)

References 54 publications

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“…15,16) This pain can be misinterpreted as typical postoperative pain, inflammatory changes, or atypical trigeminal neuralgia. 13,18) Therefore, detailed knowledge of these pain patterns and the latent period of FBS, and repetitive evaluation of mealrelated pain, even during the follow-up, are clues to its ac-curate diagnosis. Although conservative management can relieve this pain for several months, excruciating pain associated with meals significantly impairs the patients' quality of life, even transiently, and the majority of cases remain in partial resolution.…”

Section: Discussionmentioning

confidence: 99%

“…The current theory of the cause of FBS is an imbalance in autonomic nerve innervation between these nervous systems. 18) The denervation of sympathetic nerve branching to the parotid gland due to surgical intervention is assumed to induce parasympathetic cross-stimulation of sympathetic receptors. This denervation results in overcontraction of myoepithelial cells and meal-related pain.…”

Section: Discussionmentioning

confidence: 99%

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First Bite Syndrome after Carotid Endarterectomy for High Carotid Bifurcation and Extensive Lesions: Two Case Reports and Literature Review

Akiyama

Hitotsumatsu

2022

NMC Case Report Journal

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First bite syndrome (FBS) is an extremely rare complication of carotid endarterectomy (CEA). FBS presents with unique characteristics, development of brief and intense pain in the ipsilateral parotid region at the first bite of each meal, and improvement with subsequent mastication. Here, we report two cases of FBS following CEA. Both cases had anatomical difficulty of a high carotid bifurcation and a high cervical lesion. The lingual and facial arteries (or their common arterial trunk) branched off the external carotid artery (ECA) close to a high carotid bifurcation. The operations required exposure of the ECA distal to these two branches and the distal internal carotid artery (ICA) with a wider range of dissection for clamping the vessels. Several days or weeks after CEA, the patients developed FBS, and their meal-related pain completely resolved in the ensuing weeks. Especially in patients with a high carotid bifurcation, several branches of the ECA tend to originate from the proximal portion of the ECA, similar to octopus arms. During CEA, in these patients, dissection around the ECA and its branches in a wider range is required for exposure of each vessel and placement of the cross-clamp. These procedures can lead to injury to the external carotid nerve and plexus, possibly causing FBS. Additionally, because of the close location of the superior cervical ganglion, external carotid nerves, and distal ICA, manipulation for exposure of the distal end of a high plaque can increase the risk of injury to the cervical sympathetic nerves.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

First Bite Syndrome after Carotid Endarterectomy for High Carotid Bifurcation and Extensive Lesions: Two Case Reports and Literature Review

Akiyama

Hitotsumatsu

2022

NMC Case Report Journal

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“…Our additional case of a diabetic patient with IPP demonstrated negligible improvement in first bite pain with botulinum toxin A treatment. Previous reviews have supported the hypothesis that FBS is attributable to an imbalance between sympathetic and parasympathetic innervation of the parotid gland and is responsive to botulinum toxin A [ 14 ]. The fact that botulinum toxin A was ineffective in our patient further suggests that the pathophysiology of IPP is possibly distinct from post-surgical FBS and may be related to additional factors such as autoimmunity or inflammation.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic parotid pain: a rare clinical presentation of first bite syndrome without history of head and neck surgery or underlying malignancies

Saleem

Bhuiya

Tham

et al. 2022

Journal of Surgical Case Reports

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First bite syndrome (FBS) has been previously characterised as a surgical complication, following head and neck surgical procedures. There are also rare reports in the literature associating FBS with malignancies of the head and neck. The term ‘idiopathic parotid pain’ (IPP) has been used recently to describe an exceedingly rare clinical presentation similar to FBS, but without history of head and neck surgery or malignancy. We present the rare case of a 65-year-old male diagnosed with IPP, our work-up and management.

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“…The pain lasts seconds to a few minutes and this syndrome is sometimes misdiagnosed as atypical trigeminal neuralgia, but sodium blockers are largely ineffective. In contrast, botulinum toxin injections and medications used for the treatment of neuropathic pain are generally useful (29). However, since the syndrome is rather rare, there is no consensus regarding treatment of FBS, as evidence is limited to case reports/series.…”

Section: First Bite Syndromementioning

confidence: 99%

Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes

May,

Benoliel,

Imamura

et al. 2023

Cephalalgia

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Background Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders. Conclusion In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.

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First Bite Syndrome: What Neurologists Need to Know

Cited by 12 publications

References 54 publications

First Bite Syndrome after Carotid Endarterectomy for High Carotid Bifurcation and Extensive Lesions: Two Case Reports and Literature Review

First Bite Syndrome after Carotid Endarterectomy for High Carotid Bifurcation and Extensive Lesions: Two Case Reports and Literature Review

Idiopathic parotid pain: a rare clinical presentation of first bite syndrome without history of head and neck surgery or underlying malignancies

Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes

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