Ineffective Ineffective Precipitated pain Ineffective Ineffective Reduced duration of pain. Postoperative posteroanterior radiograph of the mandible taken when the patient presented with pain showing flaring of the mandibular rami (Oral and Facial Department, Mid Yorkshire Hospitals Trust 2014). Postoperative orthopantogram taken when patient presented with pain showing the calcified stylohyoid ligament (Oral and Facial Department, Mid Yorkshire Hospitals Trust 2014).Ĭo-codamol and immediate-release morphine (Oramorph® (Boehringer Ingelheim) 5–40 mg 30 min before food) Oxycodone (10–20 mg 30 min before food) Methadone (5–10 mg 3 times a day) Benzocaine lozenges Hyoscine (10–20 mg) Acupuncture Gabapentin (400 mg 3 times a day)Ĭarbamazepine (200 mg 3 times a day) and amitriptyline (25 mg at night)įig. Suida / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx Table 1 Analgesia for treatment of first bite syndrome as reported in a case by Phillips and Farquar-Smith.6įig. First bite syndrome after bimaxillary osteotomy: case report. Please cite this article in press as: Scholey AL, Suida MI.

0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Plain radiographs showed that the stylohyoid ligament was elongated and calcified, and the rami of the Clinical assessment failed to show any intraoral or extraoral disease. He had had no previous operations on the head and neck. He did not smoke and there was no relevant medical history. The pain spread across his right temple and right angle of his mandible. Four months later he complained of a sensation similar to an “elastic band hitting his face” which occurred only during the first bite of every meal. He was treated successfully with oral antibiotics for a postoperative infection in the left body of his mandible. The operation went to plan and there were no complications. It involved 8 mm advancement and 3 mm impaction of the maxilla through a Le Fort I osteotomy and bilateral sagittal split osteotomy to retract and raise the mandible.

Suida).Ī supramaximal response on cross-stimulation of parasympathetic neurotransmitters on these receptors.2–4Ĭase report A 43-year-old man had bimaxillary osteotomy to correct a severe skeletal class III malocclusion. ∗∗ Corresponding author at: Oral and Facial Department, Floor C, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, United Kingdom. ∗ Corresponding author at: 75 Leeds Road, Bramhope, Leeds LS16 9BE, United Kingdom. This results in denervation and supersensitivity of the sympathetic receptors that control the myoepithelial cells. Although most cases occur as a postoperative complication it has also been reported preoperatively.1 The cause is largely unknown, but it could occur after loss of or damage to the sympathetic innervation to the parotid gland during operation. It gradually improves with each further bite and characteristically lasts a few seconds. It is the development of a severe cramping pain in the parotid region at the same side as the operation and is usually experienced after the first bite of every meal.

Introduction First bite syndrome is an uncommon complication of operations that involve the infratemporal fossa and the parapharangeal space or deep lobe of the parotid, or both. Keywords: First bite syndrome Bimaxillary osteotomy Orthognathic surgery Parotid gland Postoperative pain © 2015 The British Association of Oral and Maxillofacial Surgeons. Available online at British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxxįirst bite syndrome after bimaxillary osteotomy: case report April Louise Scholey ∗, Mohamed Imran Suida ∗∗ Pinderﬁelds General Hospital, United Kingdom Accepted 6 March 2015Ībstract We present what is to the best of our knowledge the first reported case of first bite syndrome as a delayed complication of bimaxillary osteotomy.

First bite syndrome causes