First bite syndrome: A complication of surgery involving the parapharyngeal space

Alexander G Chiu, James I. Cohen, Alan R. Burningham, Peter E. Andersen, Bruce J. Davidson

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Introduction. First bite syndrome (FBS) is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space. The cause is not clear but has been proposed to involve a loss of sympathetic nerve function to the parotid, causing a denervation supersensitivity of salivary gland myoepithelial cells. The purpose of this study was to review the records of 12 patients with FBS to determine any common features of the operations performed that would support this theory of parotid "sympathectomy" as an etiologic factor of FBS. Methods. Retrospective review of 12 patients with FBS managed at two tertiary care centers. Results. Twelve patients were diagnosed with FBS after surgery involving the parapharyngeal space. All patients had most of their parotid gland preserved. Six patients exhibited a postoperative Horner's syndrome, suggesting sympathetic chain interruption. The six patients without Horner's syndrome were found to have undergone external carotid artery ligation inferior to the parotid gland, suggesting an interruption of sympathetic innervation to the parotid gland itself. Conclusions. Preservation of parotid gland tissue and a loss of its sympathetic nerve supply, whether by disruption of the cervical sympathetic chain as evidenced by a Horner's syndrome or more selective denervation by ligation of the external carotid artery with its accompanying sympathetic nerve plexus, were common features of all patients. This series supports the concept of parotid "sympathectomy" as an etiologic factor in FBS.

Original languageEnglish (US)
Pages (from-to)996-999
Number of pages4
JournalHead and Neck
Volume24
Issue number11
DOIs
StatePublished - Nov 1 2002
Externally publishedYes

Fingerprint

Bites and Stings
Parotid Gland
Horner Syndrome
External Carotid Artery
Sympathectomy
Denervation
Ligation
Parotid Region
Salivary Glands
Tertiary Care Centers
Meals
Pain

Keywords

  • First bite syndrome
  • Horner's syndrome
  • Parapharyngeal space

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Chiu, A. G., Cohen, J. I., Burningham, A. R., Andersen, P. E., & Davidson, B. J. (2002). First bite syndrome: A complication of surgery involving the parapharyngeal space. Head and Neck, 24(11), 996-999. https://doi.org/10.1002/hed.10162

First bite syndrome : A complication of surgery involving the parapharyngeal space. / Chiu, Alexander G; Cohen, James I.; Burningham, Alan R.; Andersen, Peter E.; Davidson, Bruce J.

In: Head and Neck, Vol. 24, No. 11, 01.11.2002, p. 996-999.

Research output: Contribution to journalArticle

Chiu, AG, Cohen, JI, Burningham, AR, Andersen, PE & Davidson, BJ 2002, 'First bite syndrome: A complication of surgery involving the parapharyngeal space', Head and Neck, vol. 24, no. 11, pp. 996-999. https://doi.org/10.1002/hed.10162
Chiu, Alexander G ; Cohen, James I. ; Burningham, Alan R. ; Andersen, Peter E. ; Davidson, Bruce J. / First bite syndrome : A complication of surgery involving the parapharyngeal space. In: Head and Neck. 2002 ; Vol. 24, No. 11. pp. 996-999.
@article{c981542a9dcd429f88d7f73bcba9bfe1,
title = "First bite syndrome: A complication of surgery involving the parapharyngeal space",
abstract = "Introduction. First bite syndrome (FBS) is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space. The cause is not clear but has been proposed to involve a loss of sympathetic nerve function to the parotid, causing a denervation supersensitivity of salivary gland myoepithelial cells. The purpose of this study was to review the records of 12 patients with FBS to determine any common features of the operations performed that would support this theory of parotid {"}sympathectomy{"} as an etiologic factor of FBS. Methods. Retrospective review of 12 patients with FBS managed at two tertiary care centers. Results. Twelve patients were diagnosed with FBS after surgery involving the parapharyngeal space. All patients had most of their parotid gland preserved. Six patients exhibited a postoperative Horner's syndrome, suggesting sympathetic chain interruption. The six patients without Horner's syndrome were found to have undergone external carotid artery ligation inferior to the parotid gland, suggesting an interruption of sympathetic innervation to the parotid gland itself. Conclusions. Preservation of parotid gland tissue and a loss of its sympathetic nerve supply, whether by disruption of the cervical sympathetic chain as evidenced by a Horner's syndrome or more selective denervation by ligation of the external carotid artery with its accompanying sympathetic nerve plexus, were common features of all patients. This series supports the concept of parotid {"}sympathectomy{"} as an etiologic factor in FBS.",
keywords = "First bite syndrome, Horner's syndrome, Parapharyngeal space",
author = "Chiu, {Alexander G} and Cohen, {James I.} and Burningham, {Alan R.} and Andersen, {Peter E.} and Davidson, {Bruce J.}",
year = "2002",
month = "11",
day = "1",
doi = "10.1002/hed.10162",
language = "English (US)",
volume = "24",
pages = "996--999",
journal = "Head and Neck",
issn = "1043-3074",
publisher = "John Wiley and Sons Inc.",
number = "11",

}

TY - JOUR

T1 - First bite syndrome

T2 - A complication of surgery involving the parapharyngeal space

AU - Chiu, Alexander G

AU - Cohen, James I.

AU - Burningham, Alan R.

AU - Andersen, Peter E.

AU - Davidson, Bruce J.

PY - 2002/11/1

Y1 - 2002/11/1

N2 - Introduction. First bite syndrome (FBS) is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space. The cause is not clear but has been proposed to involve a loss of sympathetic nerve function to the parotid, causing a denervation supersensitivity of salivary gland myoepithelial cells. The purpose of this study was to review the records of 12 patients with FBS to determine any common features of the operations performed that would support this theory of parotid "sympathectomy" as an etiologic factor of FBS. Methods. Retrospective review of 12 patients with FBS managed at two tertiary care centers. Results. Twelve patients were diagnosed with FBS after surgery involving the parapharyngeal space. All patients had most of their parotid gland preserved. Six patients exhibited a postoperative Horner's syndrome, suggesting sympathetic chain interruption. The six patients without Horner's syndrome were found to have undergone external carotid artery ligation inferior to the parotid gland, suggesting an interruption of sympathetic innervation to the parotid gland itself. Conclusions. Preservation of parotid gland tissue and a loss of its sympathetic nerve supply, whether by disruption of the cervical sympathetic chain as evidenced by a Horner's syndrome or more selective denervation by ligation of the external carotid artery with its accompanying sympathetic nerve plexus, were common features of all patients. This series supports the concept of parotid "sympathectomy" as an etiologic factor in FBS.

AB - Introduction. First bite syndrome (FBS) is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space. The cause is not clear but has been proposed to involve a loss of sympathetic nerve function to the parotid, causing a denervation supersensitivity of salivary gland myoepithelial cells. The purpose of this study was to review the records of 12 patients with FBS to determine any common features of the operations performed that would support this theory of parotid "sympathectomy" as an etiologic factor of FBS. Methods. Retrospective review of 12 patients with FBS managed at two tertiary care centers. Results. Twelve patients were diagnosed with FBS after surgery involving the parapharyngeal space. All patients had most of their parotid gland preserved. Six patients exhibited a postoperative Horner's syndrome, suggesting sympathetic chain interruption. The six patients without Horner's syndrome were found to have undergone external carotid artery ligation inferior to the parotid gland, suggesting an interruption of sympathetic innervation to the parotid gland itself. Conclusions. Preservation of parotid gland tissue and a loss of its sympathetic nerve supply, whether by disruption of the cervical sympathetic chain as evidenced by a Horner's syndrome or more selective denervation by ligation of the external carotid artery with its accompanying sympathetic nerve plexus, were common features of all patients. This series supports the concept of parotid "sympathectomy" as an etiologic factor in FBS.

KW - First bite syndrome

KW - Horner's syndrome

KW - Parapharyngeal space

UR - http://www.scopus.com/inward/record.url?scp=0036839594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036839594&partnerID=8YFLogxK

U2 - 10.1002/hed.10162

DO - 10.1002/hed.10162

M3 - Article

C2 - 12410534

AN - SCOPUS:0036839594

VL - 24

SP - 996

EP - 999

JO - Head and Neck

JF - Head and Neck

SN - 1043-3074

IS - 11

ER -