Purpose of Review

Though first bite syndrome is well known in surgical settings, it is not commonly included in the differential for sharp paroxysmal facial pain in the neurology literature. This paper will highlight the clinical features and relevant anatomy of first bite syndrome, with the goal of helping clinicians differentiate this from other similar facial pain disorders.

Recent Findings

First bite syndrome is severe sharp or cramping pain in the parotid region occurring with the first bite of each meal and improving with subsequent bites. Pathophysiology has been attributed to imbalanced sympathetic/parasympathetic innervation of the parotid gland. This is seen most typically in the post-surgical setting following surgery in the parotid or parapharyngeal region, but neoplastic etiologies have also been reported. It is common for patients to present with concurrent great auricular neuropathy and/or Horner’s syndrome. Evidence regarding treatment is limited to case reports/series, however, botulinum toxin injections and neuropathic medicines have been helpful in select cases.

Summary

It is critical for clinicians to be able to differentiate first bite syndrome from other paroxysmal facial pain. To help with this, we have proposed diagnostic criteria for clinical assessment. Patients often improve gradually over time, but symptomatic treatment with botulinum toxin or neuropathic medicine may be required.

中文翻译：

---

第一口综合症：神经科医生需要知道什么

审查目的

尽管第一咬合综合征在外科手术中是众所周知的，但在神经病学文献中，它通常不包括在与剧烈阵发性面部疼痛的鉴别中。本文将重点介绍第一咬合综合征的临床特征和相关解剖结构，目的是帮助临床医生将其与其他类似的面部疼痛疾病区分开来。

最近的发现

第一口综合症是腮腺区域的剧烈剧烈疼痛或痉挛性疼痛，发生在每顿饭的第一口并随着随后的咬口而改善。病理生理学归因于腮腺的不平衡的交感神经/副交感神经支配。这在腮腺或咽旁区域手术后的手术后环境中最常见，但也报告了肿瘤病因。患者同时出现耳大神经病变和/或霍纳综合征是很常见的。有关治疗的证据仅限于病例报告/系列，但是，肉毒杆菌毒素注射液和神经病药物对特定病例有所帮助。

概括

临床医生能够区分第一次咬合综合征与其他阵发性面部疼痛至关重要。为此，我们提出了临床评估的诊断标准。患者通常会随着时间的推移逐渐好转，但可能需要使用肉毒杆菌毒素或神经病药物对症治疗。