Facial muscle spasm, also known as facial muscle twitching, mainly manifests as episodic, non-random twitching of the muscles innervated by the facial nerve, most often involving the eyelids (eyelid jumping), but also involving the cheek and corner of the mouth muscles, the affected side of the eye fissure shrinks when the attack is severe, and the corner of the mouth is pulled crooked. It often appears when fatigued or stressed, and often decreases or disappears when quiet and asleep. Facial spasm can be divided into two types: primary and secondary.
Primary facial myospasm accounts for the majority of cases. The majority of primary facial myospasms are due to compression of the brainstem segment of the facial nerve by abnormal traveling blood vessels. Secondary facial myoclonus is less common and can be due to tumors, hemangiomas, cysts, trauma in the pontocerebellar horn region, or due to lesions such as brainstem encephalitis, medullary cavernosa, or sequelae of facial neuritis. It is often accompanied by other symptoms of cranial nerve damage. The following three treatments are commonly used for facial spasm: 1. Drugs Commonly used are carbamazepine, clonazepam, baclofen, and sedatives, but in most cases the efficacy is poor. Botulinum toxin injection can only obtain short-term effect, usually 3-6 months relapse, repeated injections are needed, some patients repeatedly injected effect gradually fade, and may appear eyelid drooping, nasolabial folds shallow, corner of the mouth drooping and other symptoms. 3. Microvascular decompression Microvascular decompression is currently the internationally recognized method of choice for the treatment of primary facial spasm, with a postoperative efficiency of about 98% and a recurrence rate of about 5%. The surgery is performed under a microscope, and only a small bone window of about 2.5~3 cm in diameter is made behind the mastoid process. After finding the blood vessels compressing the facial nerve, the relevant blood vessels are separated from the nerve and appropriate materials are padded between them. The safety factor of the operation is high, and the majority of patients can recover as normal after surgery, but a very small number of patients will have complications such as facial paralysis, tinnitus, hearing loss, infection, and bleeding to varying degrees, and the mortality rate is very low or close to zero, about 0.5% or less. In summary, facial nerve microvascular decompression is currently the only method that can cure primary facial spasm with good efficacy and high safety factor, and most patients can be cured. However, botulinum toxin injection therapy is still recommended for patients with serious organic diseases of the heart, liver, lungs, and kidneys or other contraindications to surgery.