First bite syndrome after surgery for parapharyngeal space tumor

Abstract

First bite syndrome (FBS) is one of the complications after surgery for parapharyngeal space tumor, which is characterized by pain in the parotid region after the first bite of each meal. The loss of the sympathetic nerve supply to the parotid gland by surgical procedures, causing a denervation supersensitivity of salivary gland myoepithelial cells, has been proposed as an etiologic factor in FBS. Here we report our experience of two typical FBS cases, in which FBS developed after surgery for a parapharyngeal sympathetic neuroma and a deep lobe parotid tumor. Since we were not aware of FBS at the time after surgery, it was very difficult to treat and counsel these patients. In our retrospective review of patients who underwent excision of parapharyngeal space tumors, including deep lobe parotid tumors, FBS was not a rare complication. Head and neck surgeons should be aware of FBS and be cautious at the time of preoperative informed consent.