title: First-bite syndrome after parapharyngeal surgery for cervical schwannoma.
abstract: BACKGROUND
  First-bite syndrome (FBS) is a rare complication that occurs after patients undergo parapharyngeal space surgery. Characteristically, inadvertent ablation of the parotid gland's sympathetic innervation results in the development of severe parotid gland-area pain at the first bite of food.
  
  
  METHODS
  The authors evaluated a patient who underwent parapharyngeal surgery for cervical schwannoma. This surgery involved the sympathetic chain's superior cervical ganglion (SCG). With destruction of the SCG, the patient developed FBS and Horner syndrome.
  
  
  CONCLUSIONS
  Destruction of the SCG or the sympathetic postganglionic supply to the parotid gland causes severe parotid pain when food is first introduced into the mouth. The absence of discomfort during mechanical joint movements helps dentists differentiate this pain from myofascial pain or pain caused by temporomandibular dysfunction. The frequent presence of Horner syndrome also facilitates diagnosis.
authors.affiliation: Salivary Gland Center, College of Dental Medicine, Columbia University, New York City, NY, USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Mandel
authors.forename: Steven B
authors.initials: SB
authors.lastname: Syrop
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000473:pathology / Q000601:surgery; D004435:Eating; D005260:Female; D006732:Horner Syndrome / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009442:Neurilemmoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010146:Pain / Q000209:etiology* / Q000503:physiopathology; D010306:Parotid Gland / Q000294:innervation / Q000503:physiopathology*; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010614:Pharynx / Q000294:innervation / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D017783:Superior Cervical Ganglion / Q000473:pathology / Q000601:surgery*; D013562:Sympathectomy / Q000009:adverse effects; D013577:Syndrome