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Date Published: 12/09/2025
Abstract Views: 48
Views PDF: 24
DOI: 10.60137/tmhvn.v70i70.201
Issue
Vol. 70 No. 70
Section
Articles
How to Cite
Tran, V. B., Nguyen, T. L., & Nguyen, V. T. (2025). REVIEW FIRST BITE SYNDROME. Vietnam Journal of Otorhinolaryngology - Head and Neck Surgery, 70(70), 10-18. https://doi.org/10.60137/tmhvn.v70i70.201

REVIEW FIRST BITE SYNDROME

Van Buu Tran1, , Thi Luyen Nguyen1, Viet Thai Nguyen2
1 Khoa Liên chuyên khoa, Bệnh viện đa khoa khu vực Bắc Quảng Bình
2 Bệnh viện đa khoa khu vực Bắc Quảng Bình

Main Article Content

Abstract

Background: Although first bite syndrome is well known in surgical settings, it has been largely neglected in Vietnamese medical literature. This paper will highlight the clinical features and relevant anatomy, the current understanding of the pathophysiology, the diagnosis of first bite syndrome, and analyse the various treatment options available to the Vietnamese otorhinolaryngologists to manage this syndrome. Methods: Studies were identified by performing a systematic search of English language literature in PubMed with the following search terms were used: "first bite syndrome". Reference lists of relevant articles were reviewed and cross-referenced to identify additional articles. Results: First bite syndrome is characterized by intense sharp or cramping pain in the parotid region, occurring at the initial bite of each meal and diminishing with subsequent bites. The underlying pathophysiology is believed to involve an imbalance in sympathetic and parasympathetic innervation of the parotid gland. It most commonly arises in the postoperative setting following surgical intervention in the parotid or parapharyngeal region, although neoplastic origins have also been described. Patients often present with concurrent great auricular neuropathy and/or Horner’s syndrome. While treatment options are limited to case reports and small case series, botulinum toxin injections have demonstrated to be a safe and beneficial treatment option in select cases. Conclusions: First bite syndrome results from damage to postganglionic cervical sympathetic nerve fibers, leading to an imbalance of parotid gland autonomic innervation. Otolaryngologists must be aware of this syndrome to provide preoperative counseling, recognize it following head and neck surgery, and consider it as a potential sign of malignant tumors. If the condition significantly impacts patients’ quality of life, botulinum toxin injection into the parotid gland is currently the leading treatment approach.

Keywords

First bite, Facial pain, Parotid, Head and neck surgery, Trigeminal neuralgia

Article Details

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