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: 2.02).
12/2008; 139(5):742-3. DOI: 10.1016/j.otohns.2008.08.015
Available from: Giuditta Mannelli
- "Finally, some authors   proposed intraparotid injections of botulinum toxin type A, which is a cholinergic receptor blocker. Lee et al.  observed a reduction of the severity of pain and a marked improvement of quality of life. Ali et al.  reported an even more dramatic effect in one patient with almost complete resolution of the syndrome in less than 48 h, with no recurrence of symptoms over a 10-week period after the injection. Conversely, one patient treated with acupuncture seemed to receive no benefits from it. "
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ABSTRACT: First bite syndrome (FBS) is an early postoperative pain syndrome characterized by the sudden onset of pain in the parotid region at the first bite of each meal. The etiology is not certain, hence a standardized therapy does not exist.
A 50-year old woman referred to us complaining of a swelling in the right parotid region. Fine-needle aspiration biopsy (FNAB) was diagnostic for pleomorphus adenoma of the deep lobe of the parotid gland. A 50-year old man presented with a mass in the right side of the neck, FNAB was diagnostic for parapharyngeal space neurinoma. The first patient was submitted to total parotidectomy with facial nerve preservation, the second to extracapsular dissection of the tumor. A week after surgery both patients developed FBS. A qualitative/quantitative description of pain was obtained by means of a self-coded questionnaire. The score ranges from 8 to 44, corresponding to the lowest and the highest discomfort possible, respectively. Acupuncture was used to treat these 2 patients. The treatment protocol comprised 6 sessions, one per week, lasting 30 minutes each.
Our questionnaire was administered before and after treatment and the score dropped from 33 to 25 in the female, from 30 to 15 in the male patient.
FBS is a complication of upper cervical surgery with a high morbidity rate. We describe the first two cases of FBS that were successfully treated with acupuncture in our ENT department. We believe that this procedure may represent a valid therapeutic alternative in the future.
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Available from: sciencedirect.com
- "ensitivity is thought to elicit a maximal contraction of myoepithelial cells during the first bite of a meal that subsides with continued masticatory action . The concept that pain is elicited ultimately by myoep - ithelial contraction led to the hypothesis that paralysis of these myoepithelial filaments with BTX may relieve FBS symptoms . In 2008 Ali et al . ( 2008 ) reported the first documented use of BTX in the treatment of FBS , thereby adding another applica - tion of Botox in the medical field . The operative procedure involves placing the patient in supine position and infiltrating the area some local anesthetic . The area where the patient feels the most intense pain is marked preoperative"
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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
Available from: Natalie Oker
- "In a preliminary series of five patients, Lee et al.  observed a reduction of the severity of pain and a marked improvement of quality of life. Ali et al.  reported an even more dramatic efficacy, but in only one patient with almost complete resolution of the syndrome in less than 48 hours, with no recurrence of symptoms for a period of 10 weeks after the injection. The efficacy of these treatment protocols remains to be demonstrated and must be compared with the natural history of the syndrome, which tends to wane over a period of several months, probably due to nerve regrowth. "
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First Bite Syndrome (FBS) is a rare pain syndrome sometimes occurring after surgery of the upper cervical region. It presents as excruciating pain, triggered at the beginning of a meal by chewing, swallowing or even simple contact with generally acidic food, waning on subsequent bites and recurring with identical features after pausing for several minutes or at the next meal.
Retrospective review of 17 patients who developed FBS after upper cervical surgery.
Seventeen patients developed FBS between 1999 and 2010 following surgery for paraganglioma in eight cases, vagal or sympathetic schwannoma in five cases (including one malignant tumour), pleiomorphic adenoma in three cases and Warthin's tumour of the deep lobe of the parotid in one case. The cervical sympathetic trunk was sacrificed in 10 cases and the external carotid artery was ligated in six cases. Horner's sign was observed postoperatively in 12 patients. The characteristic pain of FBS was triggered by chewing or simple contact with essentially acidic food.
FBS must be identified by the head and neck surgeon and distinguished from the usual postoperative pain. The generally accepted hypothesis is that of sympathetic denervation with parasympathetic secretory hyperactivity, but Horner's sign was present in only 12 of the 17 patients of our series, suggesting that other pathogenic mechanisms may be involved. FBS is difficult to treat, but the pain gradually becomes less severe. The patient must be informed about this rare complication that can impact on postoperative quality of life.
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