頸部廓清手術後發生初次咀嚼症候群

First Bite Syndrome Following Neck Dissection

黃同村(Tung-Tsun Huang) ； 徐莉萍(Lee-Ping Hsu) ； 陳培榕(Peir-Rong Chen)

《台灣耳鼻喉頭頸外科雜誌》 45卷6期 (2010/12) Pp. 182-185

https://doi.org/10.6286/2010.45.6.182

摘要

初次咀嚼症候群(first bite syndrome)是指於每次進食初次咀嚼時，在腮腺區域發生疼痛的現象，可能發生於咽旁間隙(parapharyngeal space)手術後。其真正致病原因尚不清楚，可能是腮腺因手術失去交感神經支配後，引發肌皮細胞(myoepithelial cell)去神經化過敏現象(denervation supersensitivity)導致。本科經歷1名口腔癌患者，因右側頸部淋巴結腫瘤復發接受頸部廓清手術，由於腫瘤復發之淋巴結往上延伸至咽旁間隙及腮腺深葉部位，所以手術時同時切除部分腮腺，以便完整移除有病變之淋巴結以及淋巴結周圍之部分咽旁間隙組織。手術後傷口復原情形良好，然而術後第7天起病患開始抱怨於每次進食時，右側腮腺部位出現劇烈疼痛的現象，在初次咀嚼時最厲害，之後逐漸減輕，約30秒後疼痛消失，但在下一次進食時又復發。雖給予止痛藥，但仍不能消除疼痛現象，加上carbamazepine使用之後，疼痛也只是減輕，並未消失。病患於術後3週開始接受放射治療，於放射治療期間初次咀嚼疼痛的現象逐漸消失。由於初次咀嚼症候群臨床上少見，頸部廓清手術後併發此症之情形更是罕見，容易被臨床醫師忽略，特提出報告。

關鍵字

初次咀嚼症候群 ； 咽旁間隙 ； 頸部廓清手術

並列摘要

First bite syndrome is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space. The exact mechanism is not clear but has been proposed to involve the loss of sympathetic nerve function to the parotid, causing a denervation supersensitivity of salivary gland myoepithelial cell. We experienced an oral cancer patient who underwent right neck dissection due to recurrent neck lymphatic metastasis. The metastatic node extended upwardly to right parapharyngeal space and involved the deep lobe of right parotid gland, thus part of right parotid gland was also removed for en bloc resection of the diseased node. The wound healed well after the surgery. However, he complained of intense and sharp pain on right parotid area upon food intake 7 days after the surgery. The pain was worse at the first bite and improved with subsequent bites. The pain lasted about 30 seconds but recurred at the start of the next meal. Non-steroid anti-inflammatory drug was given but in vain. He received carbamazepine thereafter, which relieved the pain partially. Postoperative radiotherapy started 3 weeks after the surgery. The pain at first bite decreased gradually and finally disappeared during the period of radiotherapy. First bite syndrome is rare and easily overlooked by the clinician; therefore we are reporting the case here.

並列關鍵字

first bite syndrome ； parapharyngeal space ； neck dissection