#FIRST BITE SYNDROME MANUAL#

But this was not shown to be so effective. Avoidance of sialagogue foods (acid): The pain is usually intense with sialagogue foods.

#FIRST BITE SYNDROME MANUAL#

Change in behavior: Manual compression of the painful region by the patient sometimes helps to relieve the pain, leading the patient to press on the painful region preventively before taking the first bite.But following treatment options are considered in those patients who are very symptomatic. In most patients the symptoms are tolerable and tends to diminish over time or may resolve spontaneously. There exists no definitive treatment for this condition. What’s the treatment for first bite syndrome This is to exclude a tumor of the deep lobe of the parotid gland, submandibular gland or ipsilateral parapharyngeal space, as the tumor may only become visible several months after onset of the pain. Imaging is needed when a patient presents with similar condition, in the absence of a history of ipsilateral upper neck surgery. Temporo-Mandibular Joint Dysfunction / TMJ Syndromeįirst bite syndrome is a clinical diagnosis and needs no special investigations for diagnosis, when it occurs during the days following neck surgery.Differential diagnosisįollowing are some clinical conditions which may mimic first byte syndrome in clinical presentation. Some patients may have pain even while thinking of food, due to the salivation that occurs. Patients may even avoid eating due to the severity of this syndrome. In some patients, the symptoms can be very intense making eating difficult which can even affect quality of life. Hence the exact prevalence of the disease after head and neck surgeries is unknown. Literature reports an incidence of 7-10% after surgeries of infratemporal fossa, deep lobe of the parotid gland and parapharyngeal space. Most often, first bite syndrome is a minor complication, which often goes unnoticed. Lateral head and neck erythema and excessive sweating triggered by eatingĪberrant sympathetic-parasympathetic sprouting.Ĭervical sympathetic vasomotor and sudomotor nerve lesions Irritating-hyperactive sympathetic trunk lesion Ptosis, myosis, enophthalmos, hemifacial anhidrosisĭeficient-destructive sympathetic trunk lesionĮyelid retraction, mydriasis, exophthalmos, hemifacial hyperhidrosis Intra-parotid sympathetic deafferentation and parasympathetic re-afferentation Syndromes associated with cervical sympathetic trunk injury. There are various other clinical syndromes also which are associated with cervical sympathetic trunk injury. However, this hypothesis has not been proven, because not all patients who have undergone sectioning of the cervical sympathetic chain during surgery have this complication. Uninhibited release of parasympathetic neurotransmitters (acetylcholine) during salivation and mastication would results in “supramaximal” contraction of the myoepithelial cells causing pain.ĭesensitization occurs after successive bites and the symptoms improve with mastication, which then reoccur with the first bite of the next meal. It is believed that these surgeries may result in sympathetic denervation to the parotid gland, specifically to its myoepithelial cells. Myoepithelial cells of parotid gland receive dual sympathetic and parasympathetic innervation, which act synergistically and not antagonistically. Most accepted reasoning is injury to the cervical sympathetic chain during surgery. The exact etiology of first bite syndrome is still unknown. The clinical condition was first described by Haubrich in 1986 and the term “first bite syndrome” was used in 1998 by Netterville et al. The pain often radiates to the ipsilateral ear and diminishes over the next several bites. The condition is characterized by unilateral cramping or spasm in the region of the parotid gland resulting in severe pain when the patient takes the first bite of every meal in the postoperative period. Sometimes it can also be caused by a head and neck tumor itself arising in above locations. First bite syndrome is a clinical condition occurring as a complication of surgeries involving the infratemporal fossa, deep lobe of the parotid gland, parapharyngeal spaces and manipulation or ligature of the external carotid artery.