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First Bite Syndrome

DaveJay's picture
Posts: 8
Joined: Dec 2013

I am curious if anybody else has experienced this or knows anything about it.

Ever since my Extended Radical Neck Dissection surgery in December, I have been experiencing First Bite Syndrome.

It involves the first one or two bites of food at every meal, which triggers an intense, almost painful, sensation in the lower back corner of the mouth.  It is somewhat similar to the sensation when you bite into a lemon, but off to the side of the mouth.  It has been getting a bit more intense as my recovery from the surgery progresses.

It is odd in that water and thin liquids usually do not trigger it, but thick fluids, like yogurt do.  Or, of course, anything solid.  I have to just bear through those first 5 or 10 seconds, and then it goes away and I can eat normally - even though it is my new normal of small bites and careful chewing.

If I take a respite from eating for 10 minutes or so, then I have to endure this again when I resume.

My doctors say that this is rare, and some have only in the last few weeks become aware of it.  Google searches don't turn a lot up, but what is there indicates that it is related to surgery in the parapharyngeal space, but the actual cause is not understood.  And there does not seem to be a good treatment for it.

Anybody else run into this interesting torture technique?  It certainly puts a damper on snacking (which is not a bad thing, in my case).



longtermsurvivor's picture
Posts: 1845
Joined: Mar 2010

Nope, with all the afflictions i have had, somehow I have missed this one.  I have very significant facial and jaw spasm, onset a year after my second radiation.  Probably twenty times a day, it absolutely glues my mouth shut.  But it doesn't hurt much,  its more a nuisance, and it is nothing like you describe.  I did  a google search, as I honestly have not heard of this before.  And I'm pretty sure this has not been discussed here in the last couple of years.  Twill be interesting to see who else is bothered by this.


Welcome to the club.



hwt's picture
Posts: 2330
Joined: Jun 2012

I had my lower mandible replaced and neck dissection 01/2012 then rads and chemo. Not what you explained but for a year and a half. everytime I ate anything, my mouth, on the surgery side, swelled. As I continued to eat, the swelling lessened. Still an issue but recent improvement seems significant. Maybe a version of what you are dealing with???


CivilMatt's picture
Posts: 4318
Joined: May 2012


I did a Bing search and got a few hits.

Sorry for your pain, the rest of your condition I identify with (eating).


dlygoblue's picture
Posts: 28
Joined: Mar 2012


I am probably one of the few who knows exactly what you’re talking about, as I suffer (still) from First Bite Syndrome 2-1/2 years post-treatment. Neuroblastoma w/ endoscopic surgery and neck dissection (9 lymph nodels) on both sides of neck, chemo and rad treatment, all in 2011. Pain exactly as you describe in lower left jaw area. Pain subsides after a minute or 2. I haven't found much research on it, and in fact, it was the oncologist’s Nutritionist who provided me the diagnosis and name.  The syndrome substantially subsided after several months post-radiation treatment, but has never gone away completely. Doctors have recommended mouth stretching exercises. Sorry for the limited treatment info.  David L

DaveJay's picture
Posts: 8
Joined: Dec 2013

Matt, thanks for the Bing tip.  It turned up a few new hits, including a Student-Doctor/Patient forum where lots of folks, patients, chimed in on this.  All desperately wanted to know how to relieve this condition.

It appears to be related to the initial autonomic salivation response we have when first start eating.  In fact, some times, just thinking about food can trigger it, just like Pavlov's dogs.

In some cases, once radation starts damaging the salivary glands, it goes away or diminishes.  This is my current hope - my silver lining in the thunderstorm of radiation facing me.

As I am beginning to learn, with any of these kinds of side affects, there are many folks who have more difficult symptoms, some who have an easier time of it, and a few poor souls who just have the very worst.  For one fellow, he has this spasm through his entire meal, every meal for years and years.

David L, thanks for your insight and experience.  It sounds like yours lasts longer than mine currently does, but I am still in the early stages of this.  Do the mouth stretching exercises actually help?

Thanks everybody else for your comments and support. 


Posts: 1
Joined: Aug 2014

i had a modified radical neck after diagnosis of tonsil cancer. I developed first bite syndrome. Damn did it hurt when you started your first bite. Northwestern said they have seen very few. Actually two me and one other patient. They have been treating it with botox. I am kind of their first experiment literature says. 70mg. They have given me 20 in two separate appointments 10 at a time. They were to scared of complication so they wanted to titrate out the dose. It has worked. Still have it but nothing like before. I kept thinking they had broken the condyler process of my right jaw, until the surgeon told me about it. 


A lighter note. The other patient was a women. She was over 70 pounds over weight. She lost those 70 and a few more. She did not want any type of treatment. It took care of her in between meal snacking perfectly. And she felt she was blessed. 

Posts: 1
Joined: Aug 2015

Who knew such a thing existed. I have done nothing but learn about diagnoses and what they really mean for the last 6 months. Today, I was told I have FBS, and that "hopefully" it will pass as I recover. My pain is on my temple as I had my entire  right mandible removed due to Clear Cell Odonogenic Carcinoma.


Any tips on how to handle the pain. I try to massage my temple as I eat....but that really doesn't seem to help.






debbiejeanne's picture
Posts: 3095
Joined: Jan 2010

hello, lucky.  may i suggest you copy and paste your post into a new topic post so all will see it?  since this is an old post, some may skip over it.  i've never heard of this until i just read your post.  very interesting indeed.  i'm sure others could benefit from this info.

God bless you,


Posts: 1
Joined: Sep 2015

i encountered this about 2 months after finishing radiation to the lymph nodes around my jaw For NHL In June of 2014.   I had no invasive surgery, The doctors at Duke had never encountered it before. This week after research they found out about FBS and told me about it as the information reported here matches my symptoms.  So far nothing makes it better but heck, they think my lymphoma is cured so I can live with it!

Posts: 1
Joined: Dec 2015

Hi there

i was just diagnosed with FBS after it became worse over 2 years. I have never had any kind of surgery to my upper body and the Dr is very puzzled. I feel your pain, literally!


it is very embarrassing when out with groups of people as the pain can drop me to my knees


apparently any kind of treatment could be worse than the pain so we just all bear it I guess



Posts: 41
Joined: Apr 2010

Hey DaveJ, i was diagnosed with SCC stage IV tonsil with lymph nodes and had the same surgery with chemo and rads. Surgery on 1/15/15 completed rads May 1. It's been a slow recovery with the usual eating and swallowing problems I read on this site, but I want you to know you are not alone, I have the exact issue regarding the painful sensation during the first bite, although for me it occurs on the 2 and third bite as well. And It happens every time!

I'm meeting my surgeon next month for a follow up and intend to ask for his opinion, which I will share with all.

On a positive note, I was NED back in October and fully expect to be again after my upcoming January scans. 

Wishing you and everyone on this site a happy and healthy 2016.


Posts: 1
Joined: Feb 2017

Dave - I have to have my parotid gland (saliva gland) removed.  When they did the biopsy, they froze the parotid gland.  When I went home, I took something to eat and the pain just about put me to the floor.  So I waited until the freezing came out, and it was fine.  I'm reading now that after the surgery, I could have First Bite Syndrome forever!!  I sure hope that's not true.  


Posts: 1
Joined: Apr 2017


I struggle with this meal. Doc says maybe botox. First ten or twenty bites are real bad. I use an ice pack just to get over the hump...it works. 5 months out of tongue reconstruction and 44 lymph nodes removed. Might get better he says. Will update soon.


Posts: 1
Joined: Oct 2017

I have this after they removed a tumor in my retro pharyngeal space. At first the pain made me scream it hurt so much. It really took me by surprise. We tried a lot of stuff but finally got on Gabapentin. It helps some. Cymbalta was added and it helped a bit too. What REALLY DOES HELP is Doxepin Hydrochloride oral solutions. 10 mg per mL. I mix it with water and do a rinse or swish it on the left side of my mouth and it numbs it up good. 

Ive also had pain of the trigeminal nerve going into my ear and along the upper branch. They did an injection and that numbed the lower branch. 

Posts: 51
Joined: Sep 2017

Yes Dave, it's real. My surgeon knew exactly what I was talking about. Mostly triggered by anything citrus, tangy or spicy. And when it initialled began for me, it was intense and painful. It has dissipated somewhat for me now, however, I was told that botox could be done to treat it if it is a problem down the road. It is caused by parapharyngeal space surgery, as you said.

Posts: 16
Joined: Aug 2017

Chemo and Radiation for throat cancer.  After finishing up both treatments I started having this a week or so later.  It still happens if it's something with citric acid.  It was happening with everything and for more than just the first bite though for awhile. 

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