Primary First Bite Syndrome of the Parotid Gland: Case Report and Literature Review

Abstract

Objective: A case of primary first bite syndrome (FBS), diagnosed in a patient with nonspecific adenocarcinoma of the deep lobe of the parotid gland. Data Sources: A Medline literature search was conducted on PubMed, using the keywords “first bite syndrome.” Review Methods: Using primary FBS and existence of a definite etiology as inclusion criteria. Results: We report on an unusual case of primary FBS, which had no surgical history. After multiple examinations, the pain was localized to a mass in the deep lobe of the parotid gland. After tumorectomy, the FBS pain was significantly relieved. The postoperative pathological examination determined that the excised mass was a nonspecific adenocarcinoma. Reviewing the literature, we found that primary FBS was mostly caused by malignant tumors in the inferior temporal fossa, the deep lobe of the parotid gland, and (or) the parapharyngeal space. Surgery was reported to be an effective treatment. Conclusion: The case highlights the critical importance of identifying the etiology of primary FBS. When manifested with a primary FBS, malignant tumors must be high on the differential diagnosis list, especially those in the region of the inferior temporal fossa, the deep lobe of the parotid gland, and the parapharyngeal space.

Botulinum toxin A for the treatment of first bite syndrome—a systematic review

“…This systematic review examines the potential of BTA to treat FBS resulting as a surgical complication. As previously discussed, while some patients develop resolution of symptoms within 1-18 months (5,10,(19)(20)(21)(22)(23)27,52,53), up to 88% of patients continue to experience symptoms (2,5,19,24,(53)(54)(55). Botulinum toxin has had multiple applications in otolaryngology, including dystonia of the larynx (56), laryngeal granulomas (57), laryngeal joint dislocation (58), cricopharyngeal spasm (57), posterior glottic synechiae (59), blepharospasm (60), hemifacial spasm (60), temporomandibular joint disorders (61), and oromandibular dystonia (60).…”

Parotid Gland Cancer With First Bite Syndrome DetectedviaCT-Guided Fine Needle Aspiration Cytology

“…FBS is thought to be caused by sympathetic denervation of the parotid gland, resulting in pain due to overexcitation of myoepithelial cells around the parotid in vivo 38: 1454-1458 (2024) gland adenohypophysis in response to release of parasympathetic transmitters after oral intake of food (5,6). FBS occurs as a postoperative complication of parotid deep lobe tumors or parapharyngeal space tumors in >95% of cases; seven cases of parotid tumors with initial presentation of FBS have been reported (7)(8)(9)(10)(11)(12)(13). Of these, six were malignant tumors: four in the parotid gland (mucoepidermoid carcinoma, squamous cell carcinoma, adenoid cystic carcinoma, and nonspecific adenocarcinoma), one in the submandibular gland (adenoid cystic carcinoma), and one in the parapharyngeal space (monophasic synovial sarcoma).…”

Salivary duct carcinoma of the parotid gland: a review article

“…Синдромът на първата захапка (First bite syndrome -FBS) се определя от усещането за лицева болка, белязана от изразени крампи или спазми, локализирани в паротидеомасетериалната област, по-специално при първоначалното дъвчене по време на хранене и прогресивно намаляваща при следващите ухапвания (40).…”