The ossification of SHL is found in approximately 4.2% of the general population and becomes symptomatic in only 4% of these cases, with a female predominance (sex ratio 60%). The ossification of SHL is most often bilateral with unilateral symptomatology. This triggers pain and various symptoms such as earache, dysgeusia, limitation of mouth opening, an intrapharyngeal foreign body sensation, and limitation of cervical rotation. The most widely accepted theory for ES following trauma or surgery of the paracervical region is the ossification of SHL involving the compression of adjacent anatomical structures (nerves, vessels, muscles) during mobilization. The pathogenesis of Eagle Syndrome (ES) is still misunderstood, and several theories have been proposed for its etiology. Retromandibular cervical pain secondary to the elongation and ossification of the stylohyoid ligament (SHL) was officially described as a syndrome for the first time by Eagle in 1937.
FIRST BITE LICENSE
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conclusion: This association allows us to present both syndromes and to carry out an up to date pathophysiological examination and therapeutic proposals concerning FBS.
The pathophysiological explanation of FBS depends on an irritative or traumatic factor in the sympathetic nerve fibers of the parotid gland. Our case report shows, on the contrary, FBS that was associated with ES. Discussion: Usually, FBS occurs after cervical surgery, for example after resection of the stylohyoid ligament for ES. The right and left condylar x-rays (open mouth and closed mouth) revealed an elongation of both the right and left stylohyoid ligaments. Palpation was painful at a specific point in right retromandibular point region, the rest of the intraoral and extraoral examinations were normal. Medical history and clinical examination did not reveal any signs of cervical surgery or cervical trauma. Observation: A 50-year-old female patient presented complaining of right retromandibular pain, that irradiated to the right side of the mandible and right shoulder, only when eating for the first time a day and at the first bite. First-bite syndrome (FBS) is characterized by pain in the parotid and retromandibular region, when taking the first bite in a meal and occurs more or less invariably. * Correspondence: Eagle Syndrome (ES) is caused by the ossification/calcification of the stylohyoid ligament and is associated with many different symptoms such as otalgia, restricted mouth opening, or an intrapharyngeal foreign body sensation. Benat Gauthier *, Georg Ségolène and Courtois Bruno
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