First bite issues?

Continuing the discussion from Our son’s surgery yesterday with Dr. Annino:

We are awaiting a call back from Dr. Annino. Dawson feels he has FBS- it started post op day 5. He has been uncomfortable for 2 days. Being that it started over the weekend, we just called Doc today. He seems to be handling it well with Tylenol, but it is definitely uncomfortable!

Not nice! He might notice that there are certain foods which bring it on, for me it’s sweet stuff and tomatoes, so he can avoid whatever triggers his… I’m sure @Isaiah_40_31 has found keeping hydrated helps too.

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@Jules & I both had first bite syndrome. It wasn’t fun. She is correct that I found keeping my saliva dilute by drinking a lot (80+ oz non-sugary, non-caffeinated fluids/day) helped a lot in reducing my symptoms. Also, as she mentioned, some foods make it worse. I found tart things like citrus & pineapple were the worst for me but also reacted to sweet, spicy & salty. Another thing that helped me early on was putting the food in my mouth & holding it on my tongue for several seconds before starting to chew. Somehow that alerted my salivary glands w/o causing over reaction by the parotid gland from which the pain emanates.

FBS is caused by irritation to the glossopharyngeal nerve (not uncommon during ES surgery) which innervates the parotid gland among other things. It’s an over-reaction by the parotid during the first few bites when starting to eat that causes the FBS pain.

For most people, FBS goes away w/in a few months after surgery, & it does get less intense over time. My surgeon offered to Rx a nerve pain medication which I chose not to accept.

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I had first bite with my 1st side and it also triggered my TMJ to flair quite a bit which I was warned ES surgery could do. I stuck to soft foods and eventually it subsided after about a week. Mine was more on the mild side. Luckily my doc gave post-op prednisone that helped with swelling, and pain. 2nd ES surgery I had no first-bite and no TMJ flair. Go figure. I was happy not to experience it again. Hope this passes quickly.


I am on month 7-8 since surgery and still have this occur occasionally. It was worse in the first few weeks to 30-45 days post-op, but things improved thereafter and it happens infrequently now (once a week).

I think the group has recommended a lot of options to consider for improving the condition.


I’m sorry it’s stuck w/ you, @JPB. I still have it, but as you noted, it’s not nearly as bad as it was at first & is continuing to disappear. It’s only once in a great while that I get hit now.

  1. Hi everyone! I’ve been out of this forum for several years but am pleased to be returning. 2. So sorry that Dawson is having FBS. My doctor explained this as an imbalance in sympathetic and parasympathetic innervation of the parotid gland due to the surgery. I had quite a bit of pain from this after surgery that lessened over probably 4 months. As others have said, he will likely discover that certain types of food worsen the symptoms. And I found it helpful to massage the parotid for a few seconds before eating. One bright spot is that I stopped popping single bits of food into my food as a snack, and become more planful about what I wanted to eat. I also had/still slightly have really dramatic parotid activation/discomfort when I am startled (e.g., cut off while driving) or have rapid physiologic change (e.g., hot flashes, rapid temperature change on my skin when I first step into a hot shower). I wish your son rapid healing. Those were very impressive styloid images that you posted!

Really great to hear from one @onelessstyloid! It sounds like you’re doing well. Thank you for the extra info about the cause of FBS. There’s always more for us to learn. :blush: