First-Bite Syndrome: A Rare Complication of Carotid Endarterectomy

This report describes the rare complication of first-bite syndrome (FBS) after carotid endarterectomy (CEA). Although FBS is well known in otolaryngologic literature, it is rarely discussed in relation to vascular surgery. FBS is most commonly a postoperative pain syndrome that is thought to be the result of selective parotid gland sympathetic denervation. The resultant facial pain is centered around the parotid region and triggered by initiation of mastication. The pain is severe, but short in duration, and quite specific in pattern. We present a case of FBS after CEA with complex anatomy. The patient developed typical symptoms of ipsilateral parotid, mandibular pain during the postoperative course. Workup excluded other diagnoses. The symptoms were self-limiting but did not resolve completely. Vascular surgeons, who are universally aware of the presentation of Horner's syndrome, should also be aware of this rare complication with similar pathophysiology.