title: First bite syndrome as a presenting symptom of a parapharyngeal space malignancy.
abstract: BACKGROUND
  First bite syndrome is a known complication after parapharyngeal space surgery. This syndrome is usually encountered when the surgery is extensive but the parotid gland is preserved. A disruption in the balance between sympathetic and parasympathetic innervation to the parotid gland has been posited to play a role.
  
  
  METHODS
  We report a 74-year-old woman with a parapharyngeal space malignancy who presented with first bite syndrome prior to any surgical intervention. The tumor and left parotid gland were resected via a transcervical approach. During the operation, the sympathetic chain was found to be directly involved with the tumor.
  
  
  RESULTS
  The patient reported complete resolution of first bite syndrome immediately after the operation, and remained free of this symptom at 6 months' follow-up.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of first bite syndrome presenting prior to any surgical intervention. Parotidectomy, if included in the surgical plan, may lead to the resolution of first bite syndrome.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital, New York, New York, USA. Seth.Lieberman@nyumc.org
authors.forename: Seth M
authors.initials: SM
authors.lastname: Lieberman
authors.forename: Gady
authors.initials: G
authors.lastname: Har-El
mesh_terms: D000368:Aged; D004435:Eating; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008409:Mastication; D010146:Pain / Q000209:etiology*; D010306:Parotid Gland / Q000601:surgery; D010610:Pharyngeal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D010614:Pharynx / Q000294:innervation / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D013584:Sarcoma, Synovial / Q000175:diagnosis* / Q000628:therapy; D013577:Syndrome