# First bite syndrome following surgical management of primary jugular foramen lesion: Clinical experience and review of the literature

## TL;DR

This paper reports on four patients who developed mild first bite syndrome after surgery for jugular foramen lesions, suggesting a possible link to sympathetic plexus displacement.

## Contribution

The study identifies first bite syndrome as a potential postoperative outcome following jugular foramen lesion surgery, with mild symptoms and no need for treatment.

## Key findings

- Four out of 47 patients developed first bite syndrome after surgery for jugular foramen lesions.
- Symptoms were mild with an average pain intensity of 2.8 and lasted up to 25 months.
- No patients required medical treatment for first bite syndrome.

## Abstract

•First bite syndrome may occur after resection of primary jugular foramen lesions.•Symptoms of first bite syndrome is mild in these patients postoperatively.•The rationale could be push of the sympathetic plexus along the internal carotid artery.

First bite syndrome may occur after resection of primary jugular foramen lesions.

Symptoms of first bite syndrome is mild in these patients postoperatively.

The rationale could be push of the sympathetic plexus along the internal carotid artery.

This study presents patients with primary jugular foramen lesions who developed First Bite Syndrome (FBS) after surgery, and reviews the literature on advancements in treating FBS.

A retrospective review of 47 patients with primary jugular foramen lesions who underwent surgery between January 2020 and May 2022 was conducted.

FBS were identified in 4 patients (8.5%). All 4 patients underwent Infratemporal Fossa (ITF) dissection, Internal Jugular Vein (IJV) ligation, and Internal Carotid Artery (ICA) dissection. None of the patients had the External Carotid Artery (ECA) ligated. The mean duration of FBS was 16-months (range, 6–25 months) with a mean follow-up time of 22 months (range, 20–26 months). All patients reported tolerable FBS symptoms, with an average pain intensity of 2.8 (range, 2–4). None received medical treatment.

Patients with primary jugular foramen lesion who undergo ICA dissection may be at risk for developing FBS. However, symptoms are usually mild, and a conservative, wait-and-see strategy is recommended. All patients undergoing surgery for jugular foramen lesions should be informed about the potential risk of postoperative FBS.

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