Management of first bite syndrome: systematic review of recent evidence

Abstract

Objective: First bite syndrome refers to pain in the parotid region during the first bite when eating that improves with subsequent bites. There is a paucity of evidence in the literature to justify recommending optimal management therefore this study aimed to review the latest evidence for its management.

Methods: A literature search across four databases was conducted using a Population, Intervention, Comparison, Outcome-generated search strategy between 2012 and 2022. Screening was done by two reviewers according to pre-determined inclusion and exclusion criteria, demonstrated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.

Results: Eleven articles were included. Six articles used repeated botulinum toxin injection, which in all the studies resulted in complete symptoms resolution. Four articles found a watch-and-wait technique to be effective. There were conflicting results on the efficacy of medical treatments such as opioids or anticonvulsants.

Conclusion: Studies have shown that first bite syndrome symptoms eventually resolve with conservative management, but repeated botulinum toxin appeared efficacious for quicker symptom resolution. Further higher-quality studies should be conducted to identify the optimal management.

Keywords: botulinum toxins; conservative treatment; pain; parotid region.