To evaluate the clinical effectiveness of ultrasound-guided BoNT-A injection in patients with postoperative First Bite Syndrome (FBS) and to introduce a symptom-guided injection strategy termed the 'Follow-the-Pain' (FTP) technique based on patient-reported outcomes.
Approach:
Study Design: Retrospective case series of patients diagnosed with FBS following head and neck surgery treated with BoNT-A at the University of Padua.
Inclusion Criteria: Patients with clinical diagnosis of FBS, history of relevant head and neck surgery, and persistent symptoms for at least 3 months postoperatively.
Exclusion Criteria: Patients with alternative causes of facial pain, such as trigeminal neuralgia or active infections.
Key Findings:
FBS is characterized by unilateral parotid pain triggered by the first bite of a meal.
In this study, BoNT-A injections resulted in a statistically significant reduction in first-bite pain intensity as measured by patient-reported outcomes.
The proposed mechanisms of action for BoNT-A include inhibition of acetylcholine release and modulation of peripheral nociceptive pathways.
Interpretation:
The study highlights the variability in injection techniques and dosing strategies for BoNT-A in managing FBS, indicating a need for standardized protocols.
Limitations:
The study lacks a control group, which limits the ability to draw definitive conclusions about the efficacy of BoNT-A.
There is no established protocol for escalating treatment in patients who do not respond to initial BoNT-A injections.
Conclusion:
The study aims to provide a systematic approach to BoNT-A injection for FBS, potentially improving management strategies based on symptom localization.
