title: First bite syndrome following ipsilateral carotid endarterectomy.
abstract: First bite syndrome (FBS) is characterized by unilateral pain in the parotid region after the first bite of each meal, usually following ipsilateral neck surgery. The proposed mechanism is sympathetic denervation of the parotid gland, from iatrogenic injury to the sympathetic trunk supplying this gland. Local botulinum toxin injection has emerged as a promising treatment option with favorable results. To date, there are 3 published cases in the literature describing FBS after carotid endarterectomy. We present a case of a 75-year-old gentleman who developed FBS after carotid endarterectomy, to raise the awareness of this unusual and uncommon complication.
authors.affiliation: Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand. TWang@adhb.govt.nz
authors.forename: Tom Kai Ming
authors.initials: TK
authors.lastname: Wang
authors.forename: Venu
authors.initials: V
authors.lastname: Bhamidipaty
authors.forename: Murray
authors.initials: M
authors.lastname: MacCormick
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005156:Facial Neuralgia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007049:Iatrogenic Disease; D007267:Injections; D008297:Male; D008409:Mastication; D009465:Neuromuscular Agents / Q000008:administration & dosage; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D035421:Parotid Region; D013564:Sympathetic Nervous System / Q000293:injuries*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A