The pain completely disappeared after 16 repeats of SGB and did not recur for 2.5 yearsĪ case of 33-year-old man, with no prior surgical history, presented with bilateral orofacial pain consistent with FBSĬonservative therapy, including drug therapy and self-care. Kurokawa H, Takezaki T, Kawaguchi R, Nakao M, Sato N, Unetani H et alĪ case of man in his thirties with a 6-month history of pain in the parotid region that occurred after the first bite of every meal IFBS treated with repeated SGB: A case report Hence, he was referred to dental institute. He was asked to continue with the same medication, which did not give him any permanent relief. No relevant findings or abnormalities were noted except for a slight enlargement of the glands. A computed tomography scan was taken from the base of the skull to the lung apex. Ultrasonographies of both right and left parotid glands were taken. Later, he visited another two ENT specialists. The patient is unaware of the medicine prescribed. He initially visited an ENT specialist for the same, where he was diagnosed to have parotitis and was prescribed with medication which did not give any permanent relief. Later in January 2019, he started experiencing pain in the parotid region while having food. The patient's blood glucose level was in normal limits with controlled level of glycosylated hemoglobin. Since then, he is on medication for diabetes (Glycomet 250 mg). During this time, the patient was diagnosed with diabetes. Later in October 2018, he had a head injury following a fight where he was hit with a rod on the head, which was sutured, followed by which he was treated as a day-care patient. Pertaining to medical history, the patient had met with an accident in 2014 and was hospitalized for 2 months and recovery was uneventful. Because of pain during eating, the patient developed aversion for food which led to his weight loss. During dinner, the intensity of pain experienced on the first bite of the meal was least. He experiences maximum pain while having the first bite of his food in the morning, and subsequently, with every first bite of the meal in a day, he experienced pain, but the intensity of pain reduced from morning to evening. The pain was described as sharp and stabbing type. On detailed history, the patient informed that he experiences acute pain (10/10 on Numerical Rating Scale) on having the first bite of meal and gradually subsides on subsequent intake of food and subsides completely in few minutes after completion of meal. Halgekar Institute of Dental Sciences and Research Centre, Belagavi, on July 7, 2019, with a chief complaint of pain in the left and right lower jaw area for 5 months while having food. We report a unique case of IFBS occurring in a 35-year-old male patient.Ī 35-year-old male patient reported to the outpatient department of our institute, Maratha Mandal's Nathajirao G. Till date, there have been only six published reports of IFBS which includes five case reports and one case series, and none are from India. The etiology for the same still remains unknown. Apart from these, there are cases reported in the literature where the syndrome is not associated with any of the abovementioned causes and are referred to as idiopathic FBS (IFBS). The reason for occurrence of pain in these patients is due to loss of sympathetic innervations to the parotid gland postsurgically. FBS has also been reported postoperatively in cases of cervical lymph node dissection, temporomandibular joint (TMJ) replacement, carotid endarterectomy or ligation, resection of stylohyoid ligament in Eagle's syndrome, bimaxillary osteotomy, etc. The probable etiology for this syndrome could be associated with surgery to the neck, tumor of parapharyngeal space (PPS) or parotid gland. have proposed that FBS is caused by the loss of sympathetic innervations to the parotid gland, which remains the most accepted hypothesis regarding the pathogenesis of the syndrome. The pain subsides gradually by the subsequent bites, and the pain is worst with the first bite and first meal of the day. It was first described by Netterville (1998) as severe parotid pain elicited on the first bite of a meal without any prodromal symptoms. Some of which can be diagnosed clinically while others can be diagnosed only on imaging.įirst bite syndrome (FBS) is one such condition which does not show any kind of abnormality on imaging. A broad spectrum of pathological conditions can affect the parotid glands.
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