Conditions: First Bite Syndrome

 

What is First bite syndrome?

First bite syndrome is a rare condition characterized by severe facial pain experienced upon taking the first bite of food. Pain is typically described as sudden and sharp, located at or near the area in front of the ear or lower jaw, developing with the first bite of food, and quickly resolving with successive bites.

This unusual phenomenon typically affects individuals who have undergone surgery involving the upper neck, including resection of nerve tumours, deep, parotid gland surgery, particularly involving the deep lobe of the parotid gland, and deep neck lymph node excision, among others. First bite syndrome may also happen without neck surgery when a malignant tumor of a salivary gland or nearby parapharyngeal space is present.

While the exact cause of first bite syndrome remains unclear, it is believed to stem from damage or irritation to the sympathetic nerve fibers during surgery, leading to abnormal responses in the autonomic nervous system. Management of first bite syndrome may involve dietary modifications, medications to alleviate pain, and in some cases, surgical interventions to address the underlying nerve dysfunction.

What other conditions may resemble first bite syndrome?

how is first bite syndrome treated?

  • Fortunately, spontaneous resolution of first bite syndrome occurs several months to a year after its onset in a large proportion of cases.

  • Various pain medications, including non-steroidal anti-inflammatory drugs (such as ibuprofen), acetaminophen, and some prescription medications are usually partially effective.

  • Injection of botulinum toxin is reliably effective, though injection must be repeated every 3-9 months.

  • Radiation therapy to the area has been demonstrated to be effective.

  • Cases of first bite syndrome due to a cancer are treated by identifying and treating the cancer.