Idiopathic first bite syndrome treated with Rikkosan: A case report

Hayashi, Kamichika; Onda, Takeshi; Ogane, Satoru; Kamio, Takashi; Ohata, Hitoshi; Takano, Nobuo; Shibahara, Takahiko

doi:10.1016/j.ajoms.2019.03.011

Cited by 5 publications

(13 citation statements)

References 19 publications

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“…Additionally, the severity of pain necessitated treatment. Treatment for idiopathic FBS or idiopathic parotid pain includes the administration of pharmacological agents [ 16 , 17 , 19 ] and injection of botulinum toxin [ 18 ]; however, the efficacy of these treatments remains to be determined, and a radical cure for idiopathic FBS is lacking. Similar to patients with idiopathic parotid pain [ 16 ], two of our patients responded to neurotropin (Nippon Zoki Pharmaceutical Co., Ltd.).…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Pain-Related Characteristics of Idiopathic First Bite Syndrome Induced by Taste in Japanese Patients without Diabetes: A Retrospective Study of Five Cases

Chiba

Hirotani

Takahashi

2021

Pain Research and Management

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Objective. First bite syndrome (FBS) is a condition in which the first bite of each meal causes parotid pain. Etiologies of FBS include prior surgery of the upper cervical region and, rarely, head and neck tumors. Idiopathic FBS rarely presents in patients without a history of surgery or evidence of an underlying tumor. Idiopathic FBS may be categorized into two subtypes: that in patients with diabetes and that in patients without diabetes. Idiopathic FBS in patients without diabetes may be overlooked or misdiagnosed because the condition has been described only in a few case reports. We aimed to identify the clinical and pain-related characteristics of idiopathic FBS in patients without diabetes. Methods. We retrospectively analyzed the clinical data of five patients without diabetes who were diagnosed with idiopathic FBS in our department between January 2010 and December 2016. Results. Four of the five patients were female, and the overall median age was 52 years (range: 13–61). All patients immediately experienced parotid pain upon tasting food without chewing. Addition of an acidic solution to the ipsilateral posterior third of the tongue evoked parotid pain. The median degree of pain intensity and interference with eating due to pain was 9 (range: 3–10) and 9 (range: 5–10) on a numerical rating scale of 0–10, respectively. Idiopathic FBS was bilateral in two patients. Two patients had tenderness on mild pressure over the affected parotid region. Two patients presented with ipsilateral idiopathic Horner’s syndrome. Conclusions. Our findings indicate that the characteristics of idiopathic FBS in patients without diabetes are largely consistent with those previously reported in postoperative FBS, supporting the notion that idiopathic FBS is a subtype of FBS. Thus, it is necessary to consider idiopathic FBS during the evaluation of facial pain triggered at the beginning of a meal.

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Section: Discussionmentioning

confidence: 99%

“…In rare cases, FBS may be idiopathic [ 18 , 19 ]; therefore, it may be overlooked or easily misdiagnosed during the evaluation of facial pain. As such, it poses a diagnostic challenge for even the most experienced pain clinicians.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Pain-Related Characteristics of Idiopathic First Bite Syndrome Induced by Taste in Japanese Patients without Diabetes: A Retrospective Study of Five Cases

Chiba

Hirotani

Takahashi

2021

Pain Research and Management

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“…6,7 An interruption in the sympathetic system leads to denervation supersensitivity and upregulation of myoepithelial cell receptors within the parotid gland. 1,3 Subsequent gustatory stimulation elicits a supranormal response from the intact parasympathetic fibers and causes excessive myoepithelial contraction. Furthermore, the first saliva to be secreted is the most viscous, as it has a high amylase and protein content.…”

Section: Discussionmentioning

confidence: 99%

“…The combination of these 2 mechanisms leads to a sudden increase in intraluminal pressure of the parotid gland ducts that results in severe facial pain. 1…”

Section: Discussionmentioning

confidence: 99%

“…A review of the literature reveals multiple descriptions of FBS occurring as a complication of surgical procedures, including dissection of the DLP, 2,8 dissection of the PPS, 9,10 carotid endarterectomy, 5,11 and other surgery of the upper cervical region. 3,12-16 Although postoperative FBS represents more than 95% of the cases published, 4 FBS due to tumor 17,18 and FBS of unknown etiology 1,19 have also been described. Previously cited risk factors include injury to the superior cervical ganglion and ligation or resection of part of the ECA causing damage to the surrounding sympathetic plexus.…”

Section: Discussionmentioning

confidence: 99%

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First Bite Syndrome After Parotidectomy: A Case Series and Review of Literature

Gill

Goldfarb

et al. 2020

Ear Nose Throat J

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Introduction: First bite syndrome (FBS) is a rare but potentially debilitating complication observed after surgery involving the upper cervical region. Patients classically complain of severe facial pain in the ipsilateral parotid region with the first few bites of a meal. Objective: The aim of this study is to shed light on the incidence and potential risk factors of FBS, including a series of cases depicting FBS observed after parotidectomy. Methods: Retrospective review of 419 patients who underwent parotidectomy at a single tertiary care facility between December 2016 and June 2020. Results: With a mean follow-up time of 16.5 months, 8 (2%) patients were documented to have symptoms of FBS after parotid gland surgery. Six of these patients underwent partial parotidectomy by dissection of the deep lobe of the parotid (DLP). Conclusion: Patients undergoing dissection of the DLP are particularly at risk for the development of FBS. All patients should be appropriately counseled during informed consent discussions, especially in high-risk cases.

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