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Summary First Bite Syndrome
Abstract
First bite syndrome (FBS) after surgical removal of tumors of the parapharyngeal space has been reported recently. According to the literature, the cause has been estimated to involve interruptions of nerves during the surgery around the superior cervical ganglion and sympathetic nerve plexus of the external carotid artery, which cause supersensitivity of parasympathetic nerves in the parotid gland. Excessive contraction of myoepithelial cells in the parotid gland due to parasympathetic supersensitivity leads to the development of a sharp pain in the parotid region. This report includes exclusive cases of sympathetic neurilemomas of the parapharyngeal space that we had treated, along with a discussion of etiologic factors and the background of FBS.
... As a result, there is a supranormal response to parasympathetic stimulation of the myoepithelial cells, and excessive contraction of these cells causes FBS. Kawashima et al. [4] reported that FBS occurs as a result of loss of sympathetic innervation to the parotid gland from the superior cervical ganglion, and Komiyama et al. [4] considered FBS to be the result of a disorder of the sympathetic nervous system in the region between the superior cervical ganglion and sympathetic nerve plexus of the external carotid artery to immediately before the otic ganglion [16]. We thought that FBS involves changes in the composition of saliva over time. ...
First bite syndrome (FBS)is characterized by sharp pain in the parotid region at the first bite of a meal which gradually decreases as mastication continues, and is thought to be caused by sympathetic nerve damage. When FBS occurs with no history suggestive of nerve damage, it is classified as idiopathic. A case of idiopathic FBS that was treated effectively with Rikkosan is presented. The patient was an 81-year-old woman who developed sharp pain in the left parotid region with the first bite of every meal in November 2015. With no specific findings, the initial diagnosis was trigeminal neuralgia, but carbamazepine was ineffective. In February 2016, temporomandibular disorder was diagnosed as the cause of masticatory muscle pain and was treated with splinting and loxoprofen sodium, but this was also ineffective. In June 2016, a panoramic radiograph, plain craniocervical magnetic resonance imaging, and blood tests were all negative. Idiopathic FBS was diagnosed and treated by gargling and swallowing Rikkosan before meals and eating bitter or sweet foods first, followed by salty or sour foods. The FBS improved, and after 1 week, she had days with no pain. Rikkosan was discontinued after a month leading to immediate recurrence. The patient was instructed to use half the dose of Rikkosan, which was effective with no side effects. In October 2016, the patient started gargling with Rikkosan. In March 2017, the Rikkosan was discontinued and the dietary strategy was continued with no further recurrence. In this case, idiopathic FBS improved with Rikkosan treatment.
First bite syndrome (FBS), a complication associated with surgical removal of a tumor in the parapharyngeal space, is characterized by pain in the parotid area with the first bite of food, and improvement with each bite. The pain is worst with the first meal of the day, but it can develop even when thinking of eating. The literature implicates injuries of the sympathetic nerve as the cause, leading to parasympathetic nerve supersensitivity and spasms of myoepithelial cells in the parotid gland. During the two decades since April 1994, we have treated five patients who developed FBS after operations to resect the parotid tumor or parapharyngeal tumor. Herein, we report the clinical features and medications associated with each case.
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