title: First bite syndrome as presenting symptom of parapharyngeal adenoid cystic carcinoma.
abstract: BACKGROUND
  First bite syndrome refers to the development of pain in the parotid region after the first bite of each meal.
  
  
  METHODS
  A man was referred to our institution with first bite syndrome as his only symptom. Magnetic resonance imaging of the head and neck revealed a deep lobe parotid mass in close contact with the external carotid artery. Computed tomography guided fine needle biopsy indicated adenoid cystic carcinoma. Total parotidectomy was performed, with en bloc resection of the infiltrated external carotid artery and a selective neck dissection of levels Ib to III. High-weight ion radiotherapy was administered post-operatively.
  
  
  CONCLUSIONS
  First bite syndrome has hitherto only been described following parapharyngeal space surgery. We present the first case of parotid gland adenoid cystic carcinoma presenting with first bite syndrome as the only symptom. The presence of first bite syndrome should prompt the clinician to investigate the parapharyngeal space and deep lobe of the parotid gland, especially in the absence of other signs or symptoms.
authors.affiliation: Otolaryngology/Head and Neck Surgery Clinic, Department of Surgical Sciences, University of Florence, Italy. adeganello@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Deganello
authors.forename: G
authors.initials: G
authors.lastname: Meccariello
authors.forename: M
authors.initials: M
authors.lastname: Busoni
authors.forename: A
authors.initials: A
authors.lastname: Franchi
authors.forename: O
authors.initials: O
authors.lastname: Gallo
mesh_terms: D000328:Adult; D003528:Carcinoma, Adenoid Cystic / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D002342:Carotid Artery, External / Q000473:pathology; D005156:Facial Neuralgia / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D010307:Parotid Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology