First Bite Syndrome: A Rare Post-Surgical Complication Following a Carotid Body Tumor Excision

Noura M AlOtaibi; Ali N Alanzan; Abdulaziz K Aloshaywi; Naif H Alotaibi; Abdulkarim F Alanazi; Faris M Alrajhi; Jawza Meaadi

doi:10.7759/cureus.76827

First Bite Syndrome: A Rare Post-Surgical Complication Following a Carotid Body Tumor Excision

Cureus. 2025 Jan 2;17(1):e76827. doi: 10.7759/cureus.76827. eCollection 2025 Jan.

Authors

Noura M AlOtaibi^{1

2}, Ali N Alanzan³, Abdulaziz K Aloshaywi³, Naif H Alotaibi³, Abdulkarim F Alanazi³, Faris M Alrajhi³, Jawza Meaadi⁴

Affiliations

¹ Oral and Maxillofacial Surgery, University of Glasgow, Glasgow, GBR.
² Oral and Maxillofacial Surgery, King Saud University, Riyadh, SAU.
³ Dentistry, King Saud University, Riyadh, SAU.
⁴ Clinical Pharmacy and Neurology, King Saud Medical City, Riyadh, SAU.

Abstract

First bite syndrome (FBS) is characterized by intense pain in the parotid area that starts with the first bite of food spontaneously. FBS is an uncommonly observed surgical complication of head and neck surgery. A 36-year-old male patient reported extreme pain after surgical excision of a carotid body tumor (CBT) in the ipsilateral parotid gland region at the first bite of each food intake, which improves gradually with continued mastication. Several factors are believed to be responsible for this phenomenon, including injury or amputation of the cervical sympathetic trunk. Loss of sympathetic innervation makes the parotid gland hypersensitive to parasympathetic stimulation. The best treatment for FBS is not yet firmly established, even though symptoms tend to improve with time in some cases. We report this case of FBS after CBT excision to raise awareness among maxillofacial surgeons of this surgical complication.

Keywords: first bite; maxillofacial tumor surgery; neck surgery; parotid pain; severe pain.

Publication types

Case Reports