Salivary glands: first bite syndrome: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Salivary glands: first bite syndrome

Sample item

After parapharyngeal space surgery, a patient has severe cramping pain in the parotid region with the first bite of each meal that eases with continued chewing. What is the proposed mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Loss of sympathetic innervation to the parotid, causing parasympathetic hypersensitivity of myoepithelial cells

First bite syndrome follows damage to the cervical sympathetic chain in the parapharyngeal space, with denervation hypersensitivity of the myoepithelial cells to parasympathetic stimulation at the first bite. The pain eases with subsequent bites. Treatment is reassurance, carbamazepine or botulinum toxin.

Option by option

  • A. Loss of sympathetic innervation to the parotid, causing parasympathetic hypersensitivity of myoepithelial cells (correct)

    Correct. Sympathetic denervation causes the effect.

  • B. Stone in Stensen's duct

    A stone causes swelling that persists throughout the meal.

  • C. Facial nerve palsy

    Facial palsy causes weakness, not pain.

  • D. Infection of the parotid duct

    Infection would cause continuous pain and swelling.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Loss of sympathetic innervation to the parotid, causing parasympathetic hypersensitivity of myoepithelial cells. First bite syndrome follows damage to the cervical sympathetic chain in the parapharyngeal space, with denervation hypersensitivity of the myoepithelial cells to parasympathetic stimulation at the first bite.

Why is "Stone in Stensen's duct" not the answer?

A stone causes swelling that persists throughout the meal.

Why is "Facial nerve palsy" not the answer?

Facial palsy causes weakness, not pain.

Why is "Infection of the parotid duct" not the answer?

Infection would cause continuous pain and swelling.

What concept does this question test?

It tests Salivary glands: first bite syndrome in ENT. The pain eases with subsequent bites. Treatment is reassurance, carbamazepine or botulinum toxin.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Salivary glands: first bite syndrome?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.