Shaikh Noah E, Jafary Haseeb A, Behnke John W, Turner Meghan T
Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA.
Marshall University School of Medicine, Huntington, WV, USA.
Gland Surg. 2022 Jul;11(7):1251-1263. doi: 10.21037/gs-22-112.
BACKGROUND: First bite syndrome (FBS) is a rare post-surgical complication resulting in peri-parotid pain after the first bite of meals. Intra-parotid Botulinum toxin A may offer relief for these symptoms. There is no consensus on the optimal dosage, timing to symptom improvement, need for repeat injections, and safety of this treatment. The objective of this systematic review was to assess the efficacy and safety of intra-parotid Botulinum toxin A injection in treating FBS. METHODS: The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar were searched from the inception until July 2020. Case reports, case series, prospective and retrospective trials in which patients with post-surgical FBS were treated with intra-parotid botulinum toxin A injection were included. The primary outcome was improvement of FBS symptoms. Secondary outcomes were time to symptom improvement and complications. Risk of bias was assessed with National Institute of Health (NIH) Quality Assessment Tools. RESULTS: Search results yielded 41 studies. Thirty-three articles were excluded after screening titles, abstracts, and full texts, yielding eight studies, from which 22 patients were included. No studies included a control. All studies were of lower quality and had at least moderate risk of bias. The initial botulinum toxin A injection dose ranged from 10-75 U. Time from surgical treatment to injection ranged from 1 month to 3 years. Seven studies, containing 17 patients, reported individual patient outcomes. Clinical improvement was reported in 16 patients lasting between 1-30 months post injection. Eight of 8 (100%) patients receiving at least 40 U botulinum toxin A had symptom improvement. Ten of 22 (45.5%) patients received a second botulinum toxin A injection due to return of pain at a mean of 3.8 months after the first injection. Seven of 22 (38.1%) patients had complete symptom resolution at a mean of 12.1 months. There were no reported injection complications, including: facial paralysis, infection, injection site reaction, and allergic reaction. DISCUSSION: There are no controlled studies comparing intra-parotid botulinum toxin A to observation for FBS. However, botulinum toxin A appears to be a potentially safe, effective treatment.
背景：首次咬合综合征（FBS）是一种罕见的术后并发症，导致进食第一口时腮腺周围疼痛。腮腺内注射A型肉毒杆菌毒素可能缓解这些症状。对于这种治疗的最佳剂量、症状改善的时间、重复注射的必要性以及安全性，目前尚无共识。本系统评价的目的是评估腮腺内注射A型肉毒杆菌毒素治疗FBS的疗效和安全性。 方法：检索MEDLINE、Embase、Cochrane对照试验中心注册库（CENTRAL）以及谷歌学术，检索时间从建库至2020年7月。纳入对术后FBS患者进行腮腺内注射A型肉毒杆菌毒素治疗的病例报告、病例系列、前瞻性和回顾性试验。主要结局是FBS症状的改善。次要结局是症状改善的时间和并发症。采用美国国立卫生研究院（NIH）质量评估工具评估偏倚风险。 结果：检索结果产生41项研究。在筛选标题、摘要和全文后，排除33篇文章，最终纳入8项研究，共22例患者。没有研究设置对照组。所有研究质量较低，至少存在中度偏倚风险。首次肉毒杆菌毒素A注射剂量范围为10 - 75 U。从手术治疗到注射的时间范围为1个月至3年。7项研究（含17例患者）报告了个体患者结局。16例患者报告临床改善，持续时间为注射后1至30个月。8例接受至少40 U肉毒杆菌毒素A的患者中有8例（100%）症状改善。22例患者中有10例（45.5%）因首次注射后平均3.8个月疼痛复发而接受第二次肉毒杆菌毒素A注射。22例患者中有7例（38.1%）平均在12.1个月时症状完全缓解。未报告注射并发症，包括：面瘫、感染、注射部位反应和过敏反应。 讨论：尚无对照研究比较腮腺内注射A型肉毒杆菌毒素与观察治疗FBS的效果。然而，肉毒杆菌毒素A似乎是一种潜在安全、有效的治疗方法。
Laryngoscope Investig Otolaryngol. 2021-5-2
Cochrane Database Syst Rev. 2013-9-9
Cochrane Database Syst Rev. 2011-12-7
Laryngoscope Investig Otolaryngol. 2020-1-23
Cochrane Database Syst Rev. 2005-1-25
World J Gastrointest Pharmacol Ther. 2016-8-6
Toxins (Basel). 2023-12-8
J Clin Orthop Trauma. 2022-7-9
Clin Case Rep. 2024-5-8
Toxins (Basel). 2023-12-8
Gland Surg. 2022-7
Ear Nose Throat J. 2022-12
J Fam Pract. 2020-11
J Neural Transm (Vienna). 2021-4
Aesthetic Plast Surg. 2021-6
J Stroke Cerebrovasc Dis. 2020-10-9
Ear Nose Throat J. 2022-8
Oral Oncol. 2021-2
Vasc Endovascular Surg. 2021-1
Zotero 插件