Idiopathic first bite syndrome - A rare case report with review of literature

Abstract

First bite syndrome (FBS) is a condition that classically presents as severe pain in the preauricular region, initiated on the first bite of a meal. In most of the cases reported, it is associated with a history of upper neck surgery or tumor of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises due to damage to the cervical sympathetic trunk leading to the loss of sympathetic innervations to the parotid salivary gland. Literature also showed occurrence of this syndrome in individuals who had no history of parotid tumor, PPS tumor or surgery of the upper neck, and such cases are referred to as idiopathic FBS (IFBS). There are very few case reports reported on IFBS. We report the one such rare case of IFBS in a 35-year-old male, referred to the outpatient department, with a 5-month history of severe, sharp pain and bilateral swelling in the parotid region occurring only on the first bite of eating and would diminish over few minutes.

Keywords: First bite syndrome; parapharyngeal space; parotid pain; parotid swelling.

Figure 1

Photograph showing ultrasonography image with no abnormality detected except for a slight swelling in the parotid gland

Figure 2

Photograph showing computed tomography scan with no abnormality detected, only slight swelling of the parotid gland observed

Figure 3

Extraoral photograph showing mild bilateral parotid gland swelling with slight increase in the left side