Abstract:Abstract: Objective: To investigate the clinical characteristics and prognosis of first bite syndrome (FBS) and improve clinicians' understanding of complications following parapharyngeal space surgery. Methods: A retrospective analysis was conducted on the clinical features and outcomes of patients who developed FBS after parapharyngeal space surgery in the Department of Otorhinolar-yngology Head and Neck Surgery at Hunan Provincial People’s Hospital between January 2020 and January 2025. A literature review on FBS research advancements was also performed. Results: 1) Clinical characteristics: Among 43 patients undergoing parapharyngeal space tumor resection, 7 developed FBS (incidence: 16.3%), all male. Symptoms included parotid region pain during the first bite of each meal, alleviated with continued chewing but recurring at the next meal. Symptoms emerged within one week postoperatively. Most patients experienced the most severe pain during the first daily meal; a minority reported pain triggered by thinking of acidic foods, and some had pain radiating retroauricularly. Pain resolved shortly after the initial few chews in all cases. 2) Histo-pathological features: Schwannomas were the most common tumors, followed by parotid-derived tumors. 3) Prognosis: Symptoms resolved spontaneously within 1–5 months in 5 patients, while 2 patients had persistent symptoms (1 unresolved after 9 months, 1 unresolved after 12 months). Conclusion: FBS typically manifests within one week postoperatively, characterized by parotid pain during the first bite of each meal, alleviated by continued chewing but recurring at subsequent meals. Prognosis is favorable, with most cases resolving spontaneously within one year.
