title: First bite syndrome - An 11-year experience.
abstract: OBJECTIVE
  First bite syndrome is the development of pain in the ipsilateral parotid region after the first few bites of food and can be seen after surgery of the upper cervical region. The aim of this study is to highlight the etiology of this potentially debilitating chronic pain syndrome.
  
  
  METHODS
  Retrospective review of 53 patients undergoing surgery of the upper neck between 2002 and 2013.
  
  
  RESULTS
  FBS developed in 16 patients (30%). Partial resolution of FBS symptoms occurred in 69% and complete resolution in 12%, whereas 15% had no change. FBS was most common in the patients who had tumor arising from deep lobe of parotid gland in comparison with other sites (50% vs 18%, p=0.017). FBS developed in 57% of patients undergoing external carotid artery (ECA) ligation and in 12.5% of patients in whom ECA was preserved (p=0.0008). Among the patients in whom ECA was preserved, FBS developed in 43% of the patients in whom sympathetic chain was sacrificed and in 4% of the patients in whom sympathetic chain was preserved.
  
  
  CONCLUSIONS
  Present results further support the role of sympathetic chain in the development of FBS.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan; Department of Otorhinolaryngology, Gaziosmanpasa Taksim Training and Research Hospital, Turkey.
authors.forename: Mehmet Özgür
authors.initials: MÖ
authors.lastname: Avinçsal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan.
authors.forename: Yurie
authors.initials: Y
authors.lastname: Hiroshima
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Shinomiya
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Shinomiya
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan. Electronic address: naokies@med.kobe-u.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Otsuki
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Nibu
mesh_terms: D008949:Adenoma, Pleomorphic / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery; D002291:Carcinoma, Papillary; D002342:Carotid Artery, External / Q000601:surgery; D059350:Chronic Pain / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D008409:Mastication; D008875:Middle Aged; D037981:Neck Dissection; D009442:Neurilemmoma / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology*; D010235:Paraganglioma / Q000601:surgery; D010305:Parotid Diseases / Q000453:epidemiology / Q000503:physiopathology*; D010306:Parotid Gland; D010307:Parotid Neoplasms / Q000601:surgery*; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013564:Sympathetic Nervous System / Q000601:surgery*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery; D055815:Young Adult
keywords: Cervical sympathetic trunk; Deep lobe of parotid gland; External carotid artery; First bite syndrome; Parapharyngeal space