Use of Botulinum Toxin for Effective Management of First Bite Syndrome Secondary to Malignancy: A Case Report.

First bite syndrome may impact patients who have undergone treatment for head and neck malignancies as well as those who have had surgery in the parapharyngeal space. As the name suggests, upon salivating and/or taking the initial bites of a meal, severe, intense pain may result. Generally, as the patient continues to consume the meal, the symptoms will lessen but may still lead to decreased quality of life. While pharmacological options traditionally include anticonvulsants or tricyclic antidepressants, botulinum toxin injections are an effective alternative to pharmacotherapy. We report the case of a patient with squamous cell carcinoma of the head and neck who experienced first bite syndrome secondary to malignancy with noticeable response to botulinum toxin injections to the right masseter and temporalis muscles. Furthermore, we present this case, as it highlights a rare syndrome with various treatment options, including botulinum toxin, the latter without a predetermined treatment dose.