Botulinum toxin in the treatment of first bite syndrome

Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 1.72). 12/2008; 139(5):742-3. DOI: 10.1016/j.otohns.2008.08.015
Source: PubMed
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    ABSTRACT: Introduction: First bite syndrome is a condition characterised by severe facial pain brought on by the first bite of each meal. This can severely affect the patient's ability to eat. Methods: We present a 70-year-old woman for whom we performed a laser ablation of the left ear tympanic plexus, as treatment of first bite syndrome. A permeatal approach was used to raise a tympanomeatal flap. The tympanic plexus was identified on the promontory and a 4 mm2 area of the plexus was ablated using CO2 laser. The flap was repositioned and a dressing was placed with topical antibiotics. Results: At two-month follow up, there was full resolution of the patient's symptoms. Discussion: 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.
    The Journal of Laryngology & Otology 01/2014; 128(2):1-3. DOI:10.1017/S002221511300354X · 0.70 Impact Factor
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    ABSTRACT: First bite syndrome (FBS) has recently been recognized in published medical studies; however, only 2 cases have been reported in dental studies. The syndrome was defined by Netterville and Civantos and Netterville et al as originating from a postoperative complication after parapharyngeal space (PPS) surgery. The most frequent reason for PPS surgery is the presence of a deep lobe parotid gland (PG) neoplasm, with cervical schwannoma the second most common lesion mandating surgery in this space. Surgical therapeutic procedures in the PPS for these tumors can inadvertently ablate the sympathetic nerve supply to the PG. Subsequently, with the first introduction of food into the mouth, severe intense and debilitating pain will develop and radiate through the upper neck, PG, and auricular regions on the ipsilateral surgical side. The intense pain will last approximately 5 seconds.With continued mastication, the pain will subside, but not totally abate. After the meal, the pain will gradually disappear, only to return with the next masticatory period. The pain is initiated by salivation, whether by food or the thought of food and will be accentuated by acidic sialogogic foods. Usually, with the passage of time, some gradual improvement in the intensity and frequency of the pain episodes can be anticipated.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 02/2014; 72(8). DOI:10.1016/j.joms.2014.02.010 · 1.28 Impact Factor
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    ABSTRACT: The aim of this article is to review the mechanism of action, physiological effects, and therapeutic applications of botulinum neurotoxins in the head and neck area.Study designAn extensive literature search was performed using keywords. The resulting articles were analyzed for relevance in four areas: overview on botulinum neurotoxins, the role of botulinum neurotoxins in the management of salivary secretory disorders, the role of botulinum neurotoxins in the management of facial pain, and the role of botulinum neurotoxins in head and neck movement disorders. Institutional review board approval was not needed due the nature of the study.ResultsBotulinum neurotoxin therapy was demonstrated to be a valuable alternative to conventional medical therapy for many conditions affecting the head and neck area in terms of morbidly, mortality, and patient satisfaction with treatment outcomes.Conclusion Botulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.KeywordsBotulinum toxinBotoxTemporomandibular disorderDystoniaFacial pain
    Saudi Dental Journal 01/2015; 27(1). DOI:10.1016/j.sdentj.2014.10.001