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Hyponeophagia: A Measure of Anxiety in the Mouse
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First Bite Syndrome: What Neurologists Need to Know.

Stephanie J Steel1, Carrie E Robertson2

  • 1Mayo Clinic, Department of Neurology, 200 First St SW, Rochester, MN, 55905, USA.

Current Pain and Headache Reports
|March 24, 2021
PubMed
Summary
This summary is machine-generated.

First bite syndrome causes sharp facial pain with the first bite of meals. This review aids clinicians in differentiating this condition from other facial pain disorders.

Keywords:
Facial painFirst biteGreat auricularHead and neck surgeryParotidTrigeminal neuralgia

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Area of Science:

  • Neurology
  • Otolaryngology
  • Pain Medicine

Background:

  • First bite syndrome (FBS) is characterized by severe, sharp, paroxysmal facial pain localized to the parotid region.
  • This pain occurs specifically with the initial bite of each meal and typically subsides with subsequent bites.
  • While recognized in surgical contexts, FBS is often overlooked in neurological differential diagnoses for facial pain.

Purpose of the Study:

  • To elucidate the clinical features and anatomical underpinnings of first bite syndrome.
  • To equip clinicians with the knowledge to distinguish FBS from other facial pain disorders.
  • To propose diagnostic criteria for the clinical assessment of first bite syndrome.

Main Methods:

  • Review of clinical features and relevant anatomy associated with first bite syndrome.
  • Analysis of reported etiologies, including post-surgical and neoplastic causes.
  • Examination of limited treatment evidence and proposed diagnostic criteria.

Main Results:

  • First bite syndrome involves parotid region pain, triggered by the first bite and resolving with continued eating.
  • Pathophysiology is linked to imbalanced autonomic innervation of the parotid gland, often seen post-operatively.
  • Concurrent conditions like great auricular neuropathy and Horner's syndrome may be present.

Conclusions:

  • Accurate differentiation of first bite syndrome from other paroxysmal facial pain is crucial for effective management.
  • While spontaneous improvement can occur, symptomatic treatments like botulinum toxin or neuropathic medications may be beneficial.
  • Proposed diagnostic criteria aim to standardize clinical assessment and improve diagnostic accuracy.