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First bite syndrome (FBS) is characterized by unilateral pain in the parotid region after the first bite of each meal, usually following ipsilateral neck surgery. The proposed mechanism is sympathetic denervation of the parotid gland, from iatrogenic injury to the sympathetic trunk supplying this gland. Local botulinum toxin injection has emerged as a promising treatment option with favorable results. To date, there are 3 published cases in the literature describing FBS after carotid endarterectomy. We present a case of a 75-year-old gentleman who developed FBS after carotid endarterectomy, to raise the awareness of this unusual and uncommon complication.


Tom Kai Ming Wang, Venu Bhamidipaty, Murray MacCormick. First bite syndrome following ipsilateral carotid endarterectomy. Vascular and endovascular surgery. 2013 Feb;47(2):148-50

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PMID: 23223183

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