title: First Bite Syndrome After Bilateral Temporomandibular Joint Replacement: Case Report.
abstract: First bite syndrome (FBS) refers to intense pain in the parotid region, which coincides with the first bite of every meal, gradually subsides over the next several bites, but returns with the first bite of the next meal. The definitive diagnosis can be readily established by the characteristic onset of pain after the first bite of every meal. Pain is typically most intense at the first meal of the day, although some patients experience symptoms when thinking of food or salivating. FBS is a recognized complication of surgery within the parapharyngeal space; however, other surgical procedures involving the upper neck have been associated with this syndrome. The extreme rarity of FBS complicates a thorough understanding of its pathophysiology. Various medical agents have been used, with variable success, for the management of patients with FBS. Although proved effective, more radical treatment modalities are commonly reserved for persistent or refractory cases, because there is potential of spontaneous decrease in the severity of symptoms with time. This report describes the case of a patient presenting with symptoms of FBS after bilateral temporomandibular joint replacement. To the authors' knowledge, this is the first case of FBS in the literature occurring after temporomandibular joint replacement.
authors.affiliation: Research Fellow, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, OH.
authors.forename: Nada
authors.initials: N
authors.lastname: Alwanni
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Altay
authors.affiliation: Associate Professor and Chair, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, OH. Electronic address: dale.baur@case.edu.
authors.forename: Dale A
authors.initials: DA
authors.lastname: Baur
authors.affiliation: Associate Professor and Residency Program Director, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, OH.
authors.forename: Faisal A
authors.initials: FA
authors.lastname: Quereshy
mesh_terms: D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D019643:Arthroplasty, Replacement / Q000379:methods*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005157:Facial Pain / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D000077206:Gabapentin; D006801:Humans; D007595:Joint Prosthesis; D008409:Mastication / Q000502:physiology*; D010149:Postoperative Pain / Q000209:etiology; D035421:Parotid Region; D013524:Surgical Flaps / Q000637:transplantation; D013703:Temporal Muscle / Q000637:transplantation; D013704:Temporomandibular Joint / Q000601:surgery*; D019224:Temporomandibular Joint Disc / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000601:surgery; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin