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A 59-year-old female asked:

I would like to hear from anyone that knows anything about first bite syndrome. i was a victim of a violent attack and the left side of my face was badly injured to the extent i had surgery to reconstruct my face. now, i have first bite syndrome, which ev

2 doctor answers5 doctors weighed in
Dr. Gregory Johnson
Specializes in Orthodontics
Answer: : Answer: you present a complicated situation. With the accident you have had your normal anatomy changed and this may result in problems which are not normally expected. In the healing process some of the anatomy may have been compromised. Therefore many of the "usual" answers to your problemm may not apply. In complicated cases such as yours i would suggest you visit a university hospital/dental school for evaluation and help. The universities are up-to-date on all of the latest diagnostic procedures and treatment methods. The university environment also offers the widest range of possible specialties to help evaluate your problems. The university of pittsburgh school of dental medicine is one of the finest institutions of it's type in the world. They have an excellent department of head and neck specialists. I would seek out their council.
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Dr. Stephen Christensen
Family Medicine 36 years experience
I'm : I'm sorry to hear about your condition. Unfortunately, it isn't clear what really causes first-bite syndrome. It's believed that the loss of sympathetic nerve function to the parotid gland leads to "denervation supersensitivity" of the smooth muscle cells surrounding the gland's ducts. Thus, when the gland is stimulated -- that is, when you take that "first bite" -- these smooth muscle cells contract forcefully, leading to the pain you feel. Excuses aside, pain syndromes due to nerve damage (first-bite syndrome, complex regional pain syndrome, trigeminal neuralgia, et al.) can be exceedingly difficult to manage. Medications that alter pain perception (tricyclics, gabapentin, etc.) are the mainstay of treatment, but, as you've apparently discovered, they often don't do the trick. Some experts have postulated that removal of the parotid gland might address the pain in specific and stubborn cases of first-bite syndrome, but this approach is pretty radical and fraught with hazards. Recent work with botulinum toxin (i.e., botox) has shown some promise in treating first-bite syndrome. You might want to talk to your doctor about whether Botox would be useful for you.
Created for people with ongoing healthcare needs but benefits everyone.
Last updated Oct 4, 2016

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