First Bite Syndrome in Transoral Surgery for Oropharyngeal Cancer

• Published in: Otolaryngology-head and neck surgery 2024-07, Vol.171 (1), p.146-154
• Main Authors: Wistermayer, Paul R., Brown, Adam E., Cave, Taylor B., Klusovsky, Laura E., Chang, Brent A., Hayden, Richard E., Hinni, Michael L., McGary, Alyssa, Nagel, Thomas H.
• Format: Article
• Language: English
• Subjects: first bite; first bite syndrome; robotic surgery; TORS; transoral surgery
• ISSN: 0194-5998; 1097-6817; 1097-6817
• DOI: 10.1002/ohn.781

Objective First bite syndrome (FBS) is a rare complication of transoral surgery (TOS) for oropharyngeal cancer (oropharyngeal squamous cell carcinoma [OPSCC]). Risk factors for developing this complication are not well described. In this study, we attempt to identify risks for developing FBS in TOS. Study Design Retrospective chart review. Setting Tertiary care medical center. Methods This study was exempted by the Mayo Clinic institutional review board. We performed a review from January 2017 to November 2022 of all patients who underwent TOS for OPSCC by a single provider. Exclusion criteria included less than 6 months follow up, prior treatment of head and neck cancer, or incomplete records. Demographic data, comorbidities, tumor characteristics, surgical details, adjuvant treatment details, functional outcomes, and oncologic outcomes were assessed. Fisher's Exact test and Kruskal‐Wallis rank sum test were used to identify significant variables, and multivariable logistic regression was used to address confounding. Results One hundred and one patients were identified. Eighty‐nine met the inclusion criteria. The mean follow‐up was 34 months (median 33). Seven patients (7.9%) developed FBS. Palatine tumor primary (P = .041), resection of styloglossus/stylopharyngeus (P = .039), and parapharyngeal fat manipulation (P = .015) were associated with the presence of FBS. After adjusting for tumor location, manipulation of parapharyngeal fat maintained significance (P = .025). T and N staging, tumor volume, adjuvant radiation, and ligation of lingual/facial arteries were not associated with the development of FBS. Eighty‐six percent (6/7) of patients had a resolution of FBS at an average of 11.3 months. Conclusion Manipulation of the parapharyngeal space is independently associated with developing FBS in TOS in our cohort. Further confirmatory studies are warranted.