Download PDF
J Neurol Surg B Skull Base 2012; 73 - A126
DOI: 10.1055/s-0032-1312174

First-Bite Syndrome: Incidence, Risk Factors, Treatment, and Outcomes

Gary Linkov 1(presenter), Luc G. Morris 1, Jatin P. Shah 1, Dennis H. Kraus 1
  • 1Merrick, USA

Background: First-bite syndrome (FBS) refers to pain in the parotid region after the first bite of a meal. It is a potential sequela of surgery involving the infratemporal fossa (ITF), parapharyngeal space (PPS), and deep lobe of the parotid gland. The incidence, risk factors, treatment options, and outcomes of FBS remain poorly defined.

Methods: We reviewed the charts of 499 patients (mean age, 50 years; range 12–81 years) undergoing surgery of the deep lobe of the parotid gland, PPS, and ITF between 1992 and 2010. All patients were followed for a minimum of 3 months postoperatively. Patient, tumor, and FBS characteristics were analyzed. Incidence was calculated using the Kaplan-Meier method. Univariate analyses and a multivariable logistic regression model were used to identify independent risk factors for FBS. Patients developing FBS were interviewed by phone.

Results: FBS developed in 45 patients (9.6%), at mean time of 97 (6–877) days from surgery. On multivariable analysis, three variables were significant independent risk factors for FBS: sympathetic chain sacrifice (OR 4.7, P = 0.008), PPS dissection (OR 8.7, P = 0.001), and resection of only the deep lobe of the parotid gland (OR 4.2, P = 0.002). FBS developed in 48.6% of patients undergoing sympathetic chain sacrifice, 22.4% of patients undergoing PPS dissection, 38.4% of patients undergoing deep lobe parotid resection, and 0.8% of patients undergoing total parotidectomy. Partial resolution of FBS symptoms occurred in 69%, and complete resolution in 13%. Of 45 FBS patients, 15 (33%) underwent at least one type of treatment for symptomatic relief. No treatment consistently provided effective symptomatic relief. Out of 16 FBS patients interviewed, only 2 (13%) recall being informed of the risk of FBS before surgery, but 9 (56%) stated that they would have liked to know.

Conclusions: The strongest independent risk factors for FBS are: PPS dissection, deep lobe of parotid resection, and sympathetic chain sacrifice. Patients undergoing surgery with potential compromise of these anatomical sites and structures should be thoroughly counseled about the risk of developing FBS.