BACKGROUND AND OBJECTIVES: First bite syndrome is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space tumor. The purpose of this study is to report the incidence and clinical courses of first bite syndrome after surgery of parapharyngeal space tumor. SUBJECTS AND METHOD: A retrospective review was done on 22 patients diagnosed and surgically treated for tumors of the parapharyngeal space from May 2001 to September 2005. RESULTS: Seven of 22 patients were diagnosed with the first bite syndrome after the operation of the parapharyngeal space tumor. In postoperative pathology, three were pleomorphic adenoma of parotid gland, three were paraganglioma of carotid body, and remaining one was schwannoma originated from sympathetic nerve chain. The first bite syndrome developed in 1 out of 5 patients with Horner's syndrome, 2 out of 4 patients with ligation of external carotid artery above branching point of facial artery, and all three patients with paraganglioma, originated from carotid body. The pain subsided in one patient 3 months after the development of first bite syndrome, although the pain persisted in remaining 6 patients during follow-up period. CONCLUSION: First bite syndrome is a minor complication of surgery involving the parapharyngeal space. But symptoms are often mild but can be severe enough to hinder a patient's quality of life and ability to eat. Therefore, surgeons who operate in the parapharyngeal space should be aware of first bite syndrome and counsel patients regarding this potential complication.
Adenoma, Pleomorphic ; Arteries ; Carotid Artery, External ; Carotid Body ; Follow-Up Studies ; Horner Syndrome ; Humans ; Incidence ; Ligation ; Meals ; Neurilemmoma ; Paraganglioma ; Parotid Gland ; Parotid Region ; Pathology ; Quality of Life ; Retrospective Studies

A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case.
Arteriovenous Malformations/diagnosis ; Arteriovenous Malformations/complications* ; Carotid Artery, External/pathology ; Carotid Artery, Internal/pathology ; Case Report ; Cerebral Angiography ; Dura Mater/pathology ; Female ; Human ; Jugular Veins/pathology ; Magnetic Resonance Imaging ; Meningeal Neoplasms/diagnosis ; Meningeal Neoplasms/complications* ; Meningioma/diagnosis ; Meningioma/complications* ; Middle Age