First bite syndrome: Case report of 3 patients treated with botulinum toxin and review of other treatment modalities

Background. First bite syndrome is an unexpected yet relatively common complication of surgeries involving the parapharyngeal space. It can have a significant effect on both the quality of life and physical health of affected patients. This study presents 3 cases of first bite syndrome treated with botulinum toxin and a review of the current literature on available treatment modalities for first bite syndrome. Methods. Three patients with first bite syndrome were injected with 75 units of botulinum toxin into affected parotid glands, focusing on areas of greatest first bite pain. Results. Two of 3 patients experienced complete relief of symptoms for 4 to 6 months. The third patient had significant decrease in pain at 4-month follow-up. Conclusions. Many treatments for first bite syndrome have been attempted including: dietary modification, pharmacological treatments, and surgical treatments. However, few have been successful. Botulinum toxin is a safe and effective treatment for this life altering and difficult to treat first bite syndrome. (C) 2012 Wiley Periodicals, Inc. Head Neck 35: E288-E291, 2013