title: First bite syndrome: case report of 3 patients treated with botulinum toxin and review of other treatment modalities.
abstract: BACKGROUND
  First bite syndrome is an unexpected yet relatively common complication of surgeries involving the parapharyngeal space. It can have a significant effect on both the quality of life and physical health of affected patients. This study presents 3 cases of first bite syndrome treated with botulinum toxin and a review of the current literature on available treatment modalities for first bite syndrome.
  
  
  METHODS
  Three patients with first bite syndrome were injected with 75 units of botulinum toxin into affected parotid glands, focusing on areas of greatest first bite pain.
  
  
  RESULTS
  Two of 3 patients experienced complete relief of symptoms for 4 to 6 months. The third patient had significant decrease in pain at 4-month follow-up.
  
  
  CONCLUSIONS
  Many treatments for first bite syndrome have been attempted including: dietary modification, pharmacological treatments, and surgical treatments. However, few have been successful. Botulinum toxin is a safe and effective treatment for this life altering and difficult to treat first bite syndrome.
authors.affiliation: University of Arkansas for Medical Sciences, Department of Otolaryngology - Head & Neck Surgery, Little Rock, Arkansas 72205, USA. jrsims2@uams.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Sims
authors.forename: James Y
authors.initials: JY
authors.lastname: Suen
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004435:Eating; D005260:Female; D006801:Humans; D008297:Male; D008409:Mastication; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010305:Parotid Diseases / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A