title: Potential use of acupuncture in the treatment of first bite syndrome.
abstract: OBJECTIVE
  First bite syndrome (FBS) is an early postoperative pain syndrome characterized by the sudden onset of pain in the parotid region at the first bite of each meal. The etiology is not certain, hence a standardized therapy does not exist.
  
  
  METHODS
  A 50-year old woman referred to us complaining of a swelling in the right parotid region. Fine-needle aspiration biopsy (FNAB) was diagnostic for pleomorphus adenoma of the deep lobe of the parotid gland. A 50-year old man presented with a mass in the right side of the neck, FNAB was diagnostic for parapharyngeal space neurinoma. The first patient was submitted to total parotidectomy with facial nerve preservation, the second to extracapsular dissection of the tumor. A week after surgery both patients developed FBS. A qualitative/quantitative description of pain was obtained by means of a self-coded questionnaire. The score ranges from 8 to 44, corresponding to the lowest and the highest discomfort possible, respectively. Acupuncture was used to treat these 2 patients. The treatment protocol comprised 6 sessions, one per week, lasting 30 minutes each.
  
  
  RESULTS
  Our questionnaire was administered before and after treatment and the score dropped from 33 to 25 in the female, from 30 to 15 in the male patient.
  
  
  CONCLUSIONS
  FBS is a complication of upper cervical surgery with a high morbidity rate. We describe the first two cases of FBS that were successfully treated with acupuncture in our ENT department. We believe that this procedure may represent a valid therapeutic alternative in the future.
authors.affiliation: First Clinic of Otorhinolaryngology, Deparment of Surgery and Translational Medicine, University of Florence, Italy. Electronic address: francescaromanafiorini@gmail.com.
authors.forename: F R
authors.initials: FR
authors.lastname: Fiorini
authors.affiliation: First Clinic of Otorhinolaryngology, Deparment of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Santoro
authors.affiliation: First Clinic of Otorhinolaryngology, Deparment of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cristofaro
authors.affiliation: First Clinic of Otorhinolaryngology, Deparment of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Buongiorno
authors.affiliation: First Clinic of Otorhinolaryngology, Deparment of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mannelli
authors.affiliation: "Sinergie" private practice and "Panakeia", School of Naturopathy, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Picconi
authors.affiliation: First Clinic of Otorhinolaryngology, Deparment of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Gallo
mesh_terms: D015670:Acupuncture Therapy; D008949:Adenoma, Pleomorphic / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008409:Mastication; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010307:Parotid Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D013577:Syndrome