Can Masseter Botox be an effective treatment for pain associated with first bite syndrome? An MRI + ENT haven’t helped.

Question

Can masseter Botox be an effective treatment for pain associated with first bite syndrome? An MRI + ENT visit haven’t helped. Could Botox help? If not, what doctor should I see for a second opinion?

Jonathan Kulbersh, MD · Answer

Yes, Botox may improve your symptoms. I suggest getting a consultation with a cosmetic dermatologist or plastic surgeon. Hope this helps.

Jason Emer, MD · Answer

Botox may help this. You'll want to see a board-certified Doctor with experience with these types of injections. Botox results resolve in 3-4 months. Best, Dr. Emer

Monika Soni, MD · Answer

You're probably correct in that botox may help your symptoms. For best results you should be valuated in person buy a plastic surgeon or an ENT specialist.

Georgios Ziakas, MD, FACS · Answer

FBS has unclear and multi factorial etiology. Botox may provide some relief if masseter hypertrophy is a contributing factor.

Vilma Di Maria, MBBS · Answer

Thankyou for your question.Yes Botox will help with the pain. Its a very good option. The botox will train the muscle to work better and not cause the pain.I would definitely try this. Good luck

Mehdi Sina, MD · Answer

Hi,First bite syndrome has an unknown etiology but it is thought to be neuropathic. Botox prevents muscle contraction and has no effects of the nerves. You may have little to lose by trying the botox but it may not help.Best,

Amanda Maloney, MD, FRCSC · Answer

Hello and thank you for your question. I am sorry you are having to deal with this painful condition. Although I have not had to treat a patient with First Bite Syndrome with Botox, the medical literature does have a number of studies and case reports of Botox or other neuromodulators being a helpful treatment, albeit to decrease the sensation, not necessarily to create no sensation. The dose range seems to vary and I suspect it would be a trial and error approach as to how much you would need (I would probably start with 50 units, with injections spaced throughout the parotid gland and a few more concentrated in the region of maximal pain). I would recommend that you see a facial plastic surgeon (or an ENT specialist who provides Botox treatments) to do the treatments. Facial plastic surgeons initially train as ENT specialists and then go on to do further subspecialty training in facial plastic and reconstructive surgery. They are also almost certainly providing Botox in their offices for cosmetic reasons so very familiar with Botox. The training and experience in ENT disorders would give you the best chance of a successful treatment as it is important to target the parotid gland (and not the masseter muscle, which is not the problem in First Bite Syndrome). I would also comment that First Bite Syndrome is not a neuropathic pain disorder (suggested below).
In addition, I am glad your MRI was normal, however, if the First Bite Syndrome was not caused by trauma or prior surgery in the area, I would suggest that the MRI be repeated at another date as there have been reports of the inciting cause being not seen on the initial scan and yet showing up on a subsequent one. 
I hope this helps and good luck.
Dr. Amanda Maloney

Melvin Elson, MD · Answer

Masseter injection with Botox should help you a great deal so see an experienced board certified dermatologist or plastic surgeon

Leonard Grossman, MD · Answer

You're probably correct in that botox may help your symptoms. For best results you should be valuated in person buy a plastic surgeon or an ENT specialist. Good luck from New York City

Can Masseter Botox be an effective treatment for pain associated with first bite syndrome? An MRI + ENT haven’t helped.

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