First-bite syndrome after resection of the styloid process

BACKGROUND: First-bite syndrome (FBS) may occur after operations on parapharyngeal space. The main symptom is excruciating pain only after the first one or two bites of meals. OBJECTIVE: The objective of this article is to report a case of FBS after resection of the styloid process (SP). CASE REPORT: This 51-year-old woman had a 4-month history of pain on her left neck. Computed tomography scan showed a left hypertrophic SP. A diagnosis of Eagle syndrome (ES) was then established. She underwent excision of the left SP through a lateral cervicotomy. Postoperative recovery was uneventful with pain relief. However, 2 months postoperatively, intense pain appeared related to the first bite in every meal. She received 800 mg carbamazepine per day with good pain control. Medication was discontinued after 2 years with no further relapse. CONCLUSIONS: This is the first report on FBS after surgical treatment of ES. It is important to remember the possibility of the diagnosis and to maintain the patient under heavy specific medication, sometimes for longer periods.