First Bite Syndrome Following Carotid Endarterectomy

Area of Science:

• Neurology
• Vascular Surgery
• Otolaryngology

Background:

• First bite syndrome (FBS) is a rare complication typically associated with parapharyngeal space surgery.
• It presents as sharp, mastication-associated pain in the parotid region.
• The exact etiology is unknown but hypothesized to involve sympathetic denervation and parasympathetic hypersensitivity of the parotid gland.

Observation:

• A 67-year-old male patient experienced severe, intermittent pain in the parotid region after CEA for a high-position carotid plaque.
• The pain was triggered by the first bite of each meal and subsided with continued mastication.

Findings:

• The patient was diagnosed with first bite syndrome (FBS).
• Only five cases of FBS associated with CEA have been previously reported.
• High-position carotid plaque may be a risk factor for developing FBS post-CEA.

Implications:

• Clinicians, including neurologists, vascular surgeons, and otolaryngologists, should be aware of FBS as a potential complication after CEA.
• Recognition of FBS is crucial for appropriate diagnosis and management in patients undergoing CEA for high-lying carotid plaques.