First Bite Syndrome After Deep Lobe Parotidectomy: Case Report

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.