![]() ![]() The first 3 questions refer to a “qualitative” description of pain. In order to classify pain we used a self-coded subjective questionnaire that was called the “AG Questionnaire”. The second patient also developed a Horner’s syndrome within a few hours after surgery. ![]() The diagnosis was made upon clinical criteria. They both had neither previous nor concomitant pathologies.Ī week after surgery both patients developed a “first-bite syndrome”. Hence, the patient was submitted to extracapsular dissection of the tumor via a cervical approach. The contrast-enhanced CT scan raised suspicion for a cervical sympathetic chain neurinoma. The FNAB revealed parapharyngeal space neurinoma. We performed total parotidectomy with facial nerve preservation through a standard cervicotomic approach.Ī 50-year old man presented to our ENT Clinic after the onset of a mass on the right side of the neck. The lesion was submitted to ultrasound-guided fine-needle aspiration biopsy (FNAB) which suggested a diagnosis of pleomorphus adenoma of the deep lobe of the parotid gland. Herein we show the excellent outcome obtained in the first two cases of FBS after upper neck surgery for a pleomorphus adenoma of the parotid gland and a cervical sympathetic chain neurinoma, which we treated with acupuncture.Ī 50-year old woman presented to our ENT Department complaining of a swelling in the right parotid region. Due to the encouraging results that we obtained treating a preliminary case series of patients presenting SS with acupuncture, we extended its application to patients complaining of FBS. The pain may occasionally resolve spontaneously, nevertheless many treatment options were described over the years, none of which proved to be effective in the long-term.Ī randomized controlled trial supported the potential role of acupuncture in “shoulder syndrome” (SS), a syndrome whose main characteristics are pain and dysfunction after neck dissection. The etiology is not certain, hence a standardized therapy does not exist. Moreover, Deganello and other authors from then on, described FBS as a presenting symptom of parapharyngeal space tumors. More than 95% of published cases correspond to postoperative syndromes following upper neck surgery, such as resection of mixed and/or cervical sympathetic nerve tumors, deep cervical lymph node dissection, parotid gland surgery, particularly involving its deep lobe, parapharyngeal and infratemporal fossa surgery, carotid bifurcation and/or internal carotid artery surgery, and resection of the styloid process. Following this publication, several papers concerning FBS were published and different clinical variants were reported. In 1998, Netterville described “first bite syndrome” (FBS) as an early postoperative pain syndrome characterized by the sudden onset of pain in the parotid region at the first bite of each meal. We believe that this procedure may represent a valid therapeutic alternative in the future. We describe the first two cases of FBS that were successfully treated with acupuncture in our ENT department. Our questionnaire was administered before and after treatment and the score dropped from 33 to 25 in the female, from 30 to 15 in the male patient.įBS is a complication of upper cervical surgery with a high morbidity rate. The treatment protocol comprised 6 sessions, one per week, lasting 30 minutes each. Acupuncture was used to treat these 2 patients. The score ranges from 8 to 44, corresponding to the lowest and the highest discomfort possible, respectively. A qualitative/quantitative description of pain was obtained by means of a self-coded questionnaire. A week after surgery both patients developed FBS. The first patient was submitted to total parotidectomy with facial nerve preservation, the second to extracapsular dissection of the tumor. A 50-year old man presented with a mass in the right side of the neck, FNAB was diagnostic for parapharyngeal space neurinoma. Fine-needle aspiration biopsy (FNAB) was diagnostic for pleomorphus adenoma of the deep lobe of the parotid gland. The etiology is not certain, hence a standardized therapy does not exist.Ī 50-year old woman referred to us complaining of a swelling in the right parotid region. First bite syndrome (FBS) is an early postoperative pain syndrome characterized by the sudden onset of pain in the parotid region at the first bite of each meal. ![]()
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