On clinical examination, there was no abnormality detected in the oral cavity, face, and neck and no any weakness of the facial nerve was there ( Fig. The pain radiated toward parotid, temporal, and neck regions. C ASE D ESCRIPTIONĪ 46-year-old male reported to the unit of oral and maxillofacial surgery with the chief complaint of severe pain in the right preauricular region after taking first bite of each meal, which lasted for a moment and subsided with subsequent masticatory movements from last 6 months. The purpose of this paper is to report an interesting case in which presenting symptom of FBS leads to the diagnosis of squamous cell carcinoma invading to trachea and esophagus. 2 In the literature, most of the reported cases show occurrence of FBS few days after parapharyngeal surgery. This hypersensitivity is thought to elicit a supramaximal contraction of myoepithelial cells during the first bite of a meal that subsides with continued masticatory action. Most theories on the pathology of FBS revolve around the concept of sympathetic denervation of the parotid gland with subsequent hypersensitivity of myoepithelial cells to parasympathetic neurotransmitters. It has been mostly associated with surgery of the parapharyngeal space, parotid gland, and upper neck. It is recurring in nature and occurs before every meal. 1 The pain is typically worst with the first bite during the first meal of the day and gradually subsides with successive masticatory movements. I NTRODUCTIONįirst bite syndrome (FBS) is considered as a development of pain in the preauricular region triggered by gustatory stimuli. Keywords: Carcinoma, First bite, Hypopharyngeal cancer, Neck mass, Pain, Pathology. First Bite Syndrome Presenting as Initial Symptom of Soft Tissue Mass in Base of Tongue and Pharyngeal Space Lead to Diagnosis of Squamous Cell Carcinoma Invading Trachea and Esophagus: A Rare Case Report. We are reporting a rare case of preauricular pain after first bite of meal that leads to the diagnosis of squamous cell carcinoma invading the trachea and esophagus. IPP may be considered a separate disorder, in which the pain characteristics are similar to those of first bite syndrome but the clinical features and pathophysiology are different.International Journal of Head and Neck Surgery Volume 13 | Issue 2 | Year 2022įirst Bite Syndrome Presenting as Initial Symptom of Soft Tissue Mass in Base of Tongue and Pharyngeal Space Lead to Diagnosis of Squamous Cell Carcinoma Invading Trachea and Esophagus: A Rare Case Reportĭepartment of Oral and Maxillofacial Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaĬorresponding Author: Satnam S Jolly, Department of Oral and Maxillofacial Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India, Phone: +91 9914287909, e-mail: on: 29 June 2014 Accepted on: 14 July 2022 Published on: 15 September 2022 A BSTRACTįirst bite syndrome (FBS) is considered as a development of pain in the preauricular region triggered by gustatory stimuli. Postprandial pain occurred within 1–10 min after meals in six patients. The trigger factor was gustatory stimuli, and the trigger area was the posterior section of the tongue. The median intensity of the first bite pain was 8 on a numerical rating scale of 0–10. IPP developed unilaterally in seven patients and bilaterally in two. All the patients were men diagnosed with type 2 diabetes (median age, 43 years). A retrospective case review involving the clinical findings and pain characteristics of nine patients with IPP and diabetes who presented to our department between 20. This study characterized the clinical characteristics of IPP in patients with diabetes. Idiopathic parotid pain (IPP) that mimics first bite syndrome may present in patients without a history of surgery or evidence of an underlying tumor, but its clinical features are unclear. First bite syndrome, characterized by pain in the parotid region after the first bite of each meal, predominantly develops in patients who have had head and neck surgery.
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