Treatment of the First Bite Syndrome

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): María Costales-Marcos, Fernando López Álvarez, Laura Fernández-Vañes, Justo Gómez, José Luis Llorente
First bite syndrome is a potential complication of surgery involving the infratemporal fossa, deep lobe of the parotid gland and parapharyngeal space. It is described as an acute and intense pain in the parotid region caused with the first bite of each meal. It is related to damage to sympathetic innervation of the parotid gland. Parasympathetic hyperactivation is believed to stimulate an exaggerated myoepithelial cell contraction causing pain. Usual analgesic treatments have poor results. Botulinum toxin type A causes parasympathetic nerve paralysis of the parotid gland and this fact would minimise salivation and decrease first bite syndrome. The aim of this study is to show the details of the technique and our outcomes in 5 patients treated with botulinum toxin type A.



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