Session Information
Session Title: AA 2021 Virtual Posters - General Rehabilitation
Session Time: None. Available on demand.
Disclosures: Paul Ilkanich, MD: No financial relationships or conflicts of interest
Case Diagnosis: First bite syndrome (FBS) in the setting of cheek tumor resection, chemotherapy and radiation treatment.
Case Description: A 49-year-old female presented for consideration of botulinum toxin-A (BTA) injection to the left parotid gland due to first bite syndrome in the setting of a 5-year history of microcystic adnexal adenocarcinoma status post (s/p) resection, chemotherapy and radiation treatment (2016), further chemotherapy and radiation for recurrence (2019).
Setting: Outpatient Physiatry clinic.Assessment/
Results: Patient underwent 2 treatments of 80 units of BTA across 4 sites to the left parotid gland over the course of roughly 3 months. Ultrasound guidance was utilized for visualization of the gland prior to injections. She reported approximately 50% reduction in pain following the first injection and 90% reduction in pain following the second injection, no longer affecting her ability to eat.
Discussion: FBS classically presents as severe pain in the parotid region upon the first bite of a meal, and it is often associated with a history of neck surgery or tumors of the parotid gland. The cause of FBS is proposed to be due to damage of the cervical sympathetic trunk, resulting in loss of innervation to the parotid salivary gland. A major sequelae of FBS is malnutrition caused by fear of pain leading to decreased oral intake. It is imperative to consider all options that minimize the pain of FBS given the litany of issues that arise out of malnutrition.
Conclusion: BTA injection to the parotid gland has been shown to be an effective, relatively noninvasive treatment option for FBS and as such should be considered by rehabilitation physicians treating the disease.
Level of Evidence: Level V
To cite this abstract in AMA style:
Ilkanich P, Savoie A. The Role of Botulinum Toxin-A for First Bite Syndrome in a Patient with Microcystic Adnexal Adenocarcinoma of the Cheek Status-post Resection, Chemotherapy and Radiation Treatment: A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/the-role-of-botulinum-toxin-a-for-first-bite-syndrome-in-a-patient-with-microcystic-adnexal-adenocarcinoma-of-the-cheek-status-post-resection-chemotherapy-and-radiation-treatment-a-case-report/. Accessed May 25, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-role-of-botulinum-toxin-a-for-first-bite-syndrome-in-a-patient-with-microcystic-adnexal-adenocarcinoma-of-the-cheek-status-post-resection-chemotherapy-and-radiation-treatment-a-case-report/