WJNS  Vol.5 No.5 , November 2015
Successful Treatment of a Case of First Bite Syndrome without Any Cause
Background: For the first bite syndrome (FBS), various causes were suggested such as parapharyngeal space surgery, resection of styloid process, carotid endarterectomy, parotid gland tumor, submandibular gland tumor, and upper cervical surgery. Actually, the real cause of FBS is still not clear. Also, suggested methods of treatment for the FBS are botulinum toxin injection, laser tympanic plexus ablation, pharmacologic approach, and no treatment. The results of those treatments were not satisfactory. Aim: The authors tried to find out the adequate method of treatment for the FBS and also tried to figure out pathologic cause of the FBS through observation of the patient response to the treatment. Case Presentation: A 38-year-old male was presented at head and neck surgery clinic with a sharp pain on the left parotid area especially at the first bite of eating food for two days. There was no cause. The patient was given trigger point injections on his left sternocleidomastoid, masseter, and temporal muscles with left mandibular nerve block five times 3 - 4 days apart. Also small amount of oral anticonvulsants were added for four weeks. Before finishing taking oral medication, the pain was gone completely. Conclusion: The authors experienced a case of FBS with no detectable cause, and treated successfully with the methods of trigger point injection, mandibular nerve block, and oral antiepileptic medication.

Cite this paper
Chang, S. , Jun, B. , Choi, J. , Kim, J. , Jang, Y. (2015) Successful Treatment of a Case of First Bite Syndrome without Any Cause. World Journal of Neuroscience, 5, 331-333. doi: 10.4236/wjns.2015.55031.
[1]   Linkov, G., Morris, L.G., Shah, J.P. and Kraus, D.H. (2012) First Bite Syndrome: Incidence, Risk Factors, Treatment, and Outcomes. Laryngoscope, 122, 1773-1778. http://dx.doi.org/10.1002/lary.23372

[2]   Yoon, S.Z., Lee, S.I., Choi, S.U., Shin, H.W., Lee, H.W., Lim, H.J. and Chang, S.H. (2009) A Case of Facial Myofascial Pain Syndrome Presenting as Trigeminal Neuralgia. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 107, e29-e31.

[3]   Houle, A. and Mandel, L. (2014) First Bite Syndrome after Deep Lobe Parotidectomy: Case Report. Journal of Oral and Maxillofacial Surgery, 72, 1475-1479. http://dx.doi.org/10.1016/j.joms.2014.02.010

[4]   Abdeldaoui, A., Oker, N., Duet, M., Cunin, G. and Tran Ba Huy, P. (2013) First Bite Syndrome: A Little Known Complication of Upper Cervical Surgery. European Annals of Otorhinolaryngology, Head and Neck Diseases, 130, 123-129. http://dx.doi.org/10.1016/j.anorl.2012.08.001

[5]   Wang, T.K., Bhamidipaty, V. and MacCormick, M. (2013) First Bite Syndrome Following Ipsilateral Carotid Endarterectomy. Vascular and Endovascular Surgery, 47, 148-150.

[6]   Wong, E.H., Farrier, J.N. and Cooper, D.G. (2011) First-Bite Syndrome Complicating Carotid Endarterectomy: A Case Report and Literature Review. Vascular and Endovascular Surgery, 45, 459-461. http://dx.doi.org/10.1177/1538574411407084

[7]   Guss, J., Ashton-Sager, A.L. and Fong, B.P. (2013) First Bite Syndrome Caused by Adenoid Cystic Carcinoma of the Submandibular Gland. Laryngoscope, 123, 426-428.

[8]   Diercks, G.R., Rosow, D.E., Prasad, M. and Kuhel, W.I. (2011) A Case of Preoperative “First-Bite Syndrome” Associated with Mucoepidermoid Carcinoma of the Parotid Gland. Laryngoscope, 121, 760-762. http://dx.doi.org/10.1002/lary.21282

[9]   Cernea, C.R., Hojaij, F.C., De Carlucci Jr., D., Plopper, C., Vanderley, F., Guerreiro, C.A. and Viana, M.S. (2007) First-Bite Syndrome after Resection of the Styloid Process. Laryngoscope, 117, 181-182. http://dx.doi.org/10.1097/01.mlg.0000245059.40028.ed

[10]   Deganello, A., Meccariello, G., Busoni, M., Franchi, A. and Gallo, O. (2011) First Bite Syndrome as Presenting Symptom of Parapharyngeal Adenoid Cystic Carcinoma. The Journal of Laryngology & Otology, 125, 428-431. http://dx.doi.org/10.1017/S002221511000294X

[11]   Lieberman, S.M. and Har-El, G. (2011) First Bite Syndrome as a Presenting Symptom of a Parapharyngeal Space Malignancy. Head and Neck, 33, 1539-1541. http://dx.doi.org/10.1002/hed.21412

[12]   Mandel, L. and Syrop, S.B. (2008) First-Bite Syndrome after Parapharyngeal Surgery for Cervical Schwannoma. The Journal of the American Dental Association, 139, 1480-1483.

[13]   Kawashima, Y., Sumi, T., Sugimoto, T. and Kishimoto, S. (2008) First-Bite Syndrome: A Review of 29 Patients with Parapharyngeal Space Tumor. Auris Nasus Larynx, 35, 109-113.

[14]   Chiu, A.G., Cohen, J.I., Burningham, A.R., Andersen, P.E. and Davidson, B.J. (2002) First Bite Syndrome: A Complication of Surgery Involving the Parapharyngeal Space. Head and Neck, 24, 996-999.

[15]   Houle, A. and Mandel, L. (2014) First Bite Syndrome after Deep Lobe Parotidectomy: Case Report. Journal of Oral and Maxillofacial Surgery, 72, 1475-1479. http://dx.doi.org/10.1016/j.joms.2014.02.010

[16]   Sims, J.R. and Suen, J.Y. (2013) First Bite Syndrome: Case Report of 3 Patients Treated with Botulinum Toxin and Review of Other Treatment Modalities. Head and Neck, 35, E288-E291.

[17]   Lee, B.J., Lee, J.C., Lee, Y.O., Wang, S.G. and Kim, H.J. (2009) Novel Treatment of First Bite Syndrome Using Botulinum Toxin Type A. Head and Neck, 31, 989-993. http://dx.doi.org/10.1002/hed.21054

[18]   Ali, M.J., Orloff, L.A., Lustig, L.R. and Eisele, D.W. (2008) Botulinum Toxin in the Treatment of First Bite Syndrome. Otolaryngology—Head and Neck Surgery, 139, 742-743.

[19]   Amin, N., Pelser, A. and Weighill, J. (2014) First Bite Syndrome: Our Experience of Laser Tympanic Plexus Ablation. The Journal of Laryngology & Otology, 128, 166-168.

[20]   Phillips, T.J. and Farquhar-Smith, W.P. (2009) Pharmacological Treatment of a Patient with First-Bite Syndrome. Anaesthesia, 64, 97-98. http://dx.doi.org/10.1111/j.1365-2044.2008.05804.x

[21]   Prisco, L., Ganau, M., Bigotto, F. and Zornada, F. (2011) Trigeminal Neuralgia: Successful Antiepileptic Drug Combination Therapy in Three Refractory Cases. Drug, Healthcare and Patient Safety, 3, 43-45.