Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105364. doi: 10.1016/j.jstrokecerebrovasdis.2020.105364. Epub 2020 Oct 9.
A 67-year-old man with a high position carotid plaque presented with severe pain in ipsilateral parotid region several days after carotid endarterectomy (CEA). The pain occurred at the first bite of each meal and resolved as further bite. We diagnosed the pain as first bite syndrome (FBS). FBS is infrequent but known as a complication associated with parapharyngeal space surgery. The pain is characterized by sharp pain in the parotid region associated with mastication. The cause is unclear but thought to the result from sympathetic denervation of the parotid gland, followed by parasympathetic nerve hypersensitivity. Only five cases associated with carotid endarterectomy (CEA) have been reported. We should be in mind that CEA for high position plaque is one of the risk factors to cause FBS associated with CEA. Neurologists and vascular surgeons as well as otolaryngologists should all be informed FBS as one of the complications after carotid endarterectomy.
一位 67 岁男性，颈动脉斑块位置较高，在颈动脉内膜切除术（CEA）后几天出现同侧腮腺区剧烈疼痛。疼痛发生在每次进餐的第一口时，随着进一步咀嚼而缓解。我们将疼痛诊断为第一口综合征（FBS）。FBS 并不常见，但已知是咽旁间隙手术相关的并发症。疼痛的特点是咀嚼时腮腺区出现锐痛。病因不明，但认为是由于腮腺交感神经去神经支配，随后副交感神经敏感性增加所致。仅报道了 5 例与颈动脉内膜切除术（CEA）相关的病例。我们应该记住，高位斑块的 CEA 是引起与 CEA 相关的 FBS 的危险因素之一。神经科医生、血管外科医生和耳鼻喉科医生都应该了解 FBS 是颈动脉内膜切除术的并发症之一。
