title: First bite syndrome: a complication of carotid endarterectomy.
abstract: First bite syndrome (FBS) is an uncommon pain syndrome characterised by severe cramping or spasm in the parotid region with the first bite of each meal. The proposed pathogenesis is sympathetic denervation of the parotid gland secondary to iatrogenic injury with resultant cross-stimulatory parasympathetic hypersensitivity response. FBS is a potential sequela of surgeries involving the infratemporal fossa, parapharyngeal space and/or deep lobe of the parotid gland, however, only four cases of FBS secondary to carotid endarterectomy have been documented to date. We present a case and management of a 77-year-old man who developed FBS after an ipsilateral carotid endarterectomy, to raise awareness of this complication among surgeons who operate in the neck region.
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Mary Jiayi
authors.initials: MJ
authors.lastname: Tao
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Graham
authors.initials: G
authors.lastname: Roche-Nagle
mesh_terms: D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008409:Mastication; D009120:Muscle Cramp; D010146:Pain / Q000209:etiology* / Q000601:surgery; D010306:Parotid Gland / Q000294:innervation* / Q000601:surgery; D035421:Parotid Region; D011183:Postoperative Complications / Q000601:surgery; D013035:Spasm / Q000150:complications; D013564:Sympathetic Nervous System / Q000293:injuries; D013577:Syndrome