Idiopathic first bite syndrome treated with repeated stellate ganglion blocks: a case report

Abstract

First bite syndrome (FBS) is a rare disease causative of pain in the parotid gland region at the first bite of each meal. We report patient with long-standing idiopathic FBS whose pain disappeared after repeated stellate ganglion blocks (SGB). A man aged in his thirties had 6-month history of pain in the parotid gland region that occurred immediately after the first bite of every meal. He did not have any surgery done on the right parapharyngeal area. Pain in the right parotid gland region developed 6 months before he was referred to us. Medications did not decrease the pain and the pain was so severe that the patient could not have any food. He received enteral alimentation and diclofenac. He rated the first bite pain 80 and the pain after the first bite 100 on a visual analog scale of 100. The pain did not change after 5 repeats of SGB; however, the pain after the first bite decreased after 6 repeats of SGB. The first bite pain decreased later. The pain completely disappeared after 16 repeats of SGB. The pain did not recur 2.5 years after cessation of treatment.