Eur Ann Otorhinolaryngol Head Neck Dis 2013 130:269–73. ] Laccourreye O, Werner A, Garcia D, Malinvaud D, Tran Ba Huy P, Bonfils P. Arch Otolaryngol Head Neck Surg 1998 124:1133–40 Vagal paraganglioma: a review of 46 patients treated during a 20-year period. ] Netterville JL, Jackson CG, Miller FR, Wanamaker JR, Glasscock ME. Tratamiento con toxina botulínica del síndrome del primer mordisco.
Surgical resection of tympanic or auriculo-temporal nerveĪdditional treatments mentioned by Linkov et al (2012) include total parotidectomy, acupuncture and adaptive behaviors techniques.Įxaggerated myoepithelial cell contraction resulting from stimulation from parasympathetic hyperactivation is thought to be the cause of the pain - with benefit seen from Botulinum toxin type A injection to the parotid gland 'chemodenervation' is supported as a management optionĬostales-Marcos M, López Álvarez F, Fernández-Vanes ˜ L, Gómez J, Llorente JL. Non-steroidal anti-inflammatory medication According to Costales-Marcos et al 2017īotulinum toxin injection to the parotid gland
These investigators identify that the severity of the symptoms tends to diminish over time with some reported to resolve spontaneously. Two patients received an additional 50 units through injection at 6 weeks after the initial injection and a third patient received 50 units 7 months after the initial injection. The pain did not go completely away in any patient at one month followup but did so in one patient at 3 months followup. Initial treatment of 5 patients with 30 units of botulinum neurotoxin A (3 sites in the parotid) by Costales-Marcos et al (2017) results in decrease in intensity of the pain in 4 patients from intense pain (6 to 8/10 pain scale) down to mild to moderate (2 to 6/10) at 6 month f/u. Not all patients who have undergone section of the cervical sympathetic chain develop first bite syndrome - leading to continued discussion about the etiology.ĭefinition according to Netterville et al (1998): First bite syndrome is facial pain characterized by a severe cramping or spasmwith the first bite of each meal that diminishes with time - occurring in the parotid region.Ĭharacteristically the pain is worst with the first meal of the day or following a several hour period without food and last a few seconds. Return to : Parotidectomy with Facial Nerve DissectionĪcute and intense pain in the parotid gland region associated with the initial bite with a meal thought to result from damage to the sympathetic innervation of the parotid gland leading to parasympathetic overactivity.
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