1.What is facial muscle spasm
Facial muscle spasm, also known as facial muscle twitching and lateral facial muscle spasm, is characterized by episodic, rhythmic involuntary twitching of the facial muscles on one side. The twitching usually starts from one eyelid first, and then gradually worsens and extends to the face and corners of the mouth, and can involve the ipsilateral neck in severe cases. The incidence of the disease is 1 per 100,000, mostly in middle-aged and elderly people, more women than men, and more often on the left side.
2, the etiology of facial muscle spasm
In terms of pathogenesis, the “short-circuiting” theory is now recognized by clinicians, based on the fact that the intracranial facial nerve is compressed by the abnormal vasculature of the vertebrobasilar artery system in the brainstem, and the facial nerve is pathologically stimulated to produce abnormal nerve impulses, resulting in facial muscle twitching. The cause of vascular compression of the facial nerve is currently unknown. Possible risk factors are known to include advanced age, hypertension, atherosclerosis, small posterior cranial fossa volume, and genetics. In rare cases, facial myasthenia can be secondary to intracranial tumors, aneurysms, arteriovenous malformations, brainstem lesions, and bony lesions, the chance of which is much lower than 1%.
3, clinical manifestations of facial spasm
The twitching mostly starts from around the eyes and gradually expands downward, affecting the perioral and facial expression muscles, and can involve the ipsilateral neck muscles in severe cases. There are no positive neurological signs, but some of them are peripheral facial paralysis caused by long-term illness or botulinum toxin injection.
4.How to confirm the diagnosis of facial spasm?
(1) Patient’s medical history, typical manifestations during seizures.
(2) Imaging tests such as CT and MRI of the head to rule out the possibility of secondary intracranial tumors.
(3) No history of trauma to the skull base or facial facial nerve.
(4) No history of facial paralysis or paresis before the onset of the disease.
5. What is the current status of treatment for facial spasm?
Drugs, acupuncture, physiotherapy and other treatment methods are definitely ineffective. Nerve block treatment is to use botulinum toxin and other drug injections to block the conduction function of the facial nerve, so that the facial muscle spasm is released. After the injection, the nerve conduction is blocked and the facial muscle becomes paralyzed or incompletely paralyzed immediately, but the facial muscle paralysis can recover within a few months and the facial muscle spasm then recurs. Therefore, the effect of Botox is short-lived, and most patients relapse in about 3-6 months, requiring re-injection. Common complications include facial palsy, dry eyes, diplopia, and difficulty swallowing. Repeated Botox injections may result in irreversible facial palsy, or resistance to Botox that is ineffective.
6, the main harm of facial muscle spasm
Facial muscle spasm affects the patient’s appearance, causing inconvenience to daily life and work and the patient’s lack of self-confidence. Irrecoverable facial paralysis can occur after repeated incorrect treatment. Facial myospasm itself is not lethal or disabling, and there is no possibility of self-healing.
7.Microvascular decompression provides a new way of treatment for facial spasm
Microvascular decompression is the only known method to cure facial myospasm.
Microvascular decompression was pioneered by an American neurosurgeon in the late 1960s. The procedure involves pushing away and fixing the blood vessels located at the root of the facial nerve under the operating microscope, which are abnormal and cause compression of the facial nerve, so that the blood vessels do not touch the facial nerve, thus relieving the compression of the facial nerve root and restoring the normal function of the facial nerve, so that the facial muscle twitches disappear. With the perfection of this surgical technique, especially its characteristics of minimally invasive, high safety, remarkable effect, low recurrence rate and low complication rate, especially the ability to completely preserve the function of blood vessels and nerves, it was soon accepted by neurosurgeons all over the world and has been popularized worldwide, becoming the most effective treatment for facial muscle spasm. In addition, manifest microvascular decompression has been successfully used to treat trigeminal neuralgia, glossopharyngeal neuralgia, as well as intractable vertigo, tinnitus, neurogenic hypertension, and spastic diastasis. Our treatment experience proves that the experience of the surgeon and the correct judgment and operation during surgery have an important impact on the outcome of the procedure. Microvascular decompression for facial spasm has become one of the characteristic treatment items of neurosurgery in our hospital.
8. How is microvascular decompression performed?
General anesthesia. The surgical incision is located in the hairline behind the ear, about 5-6 cm long, and the skin is incised and a microbony hole (locking hole size, usually 2.5 cm in diameter) is drilled in the skull to enter the skull. The facial nerve root is explored, the responsible vessel compressing the facial nerve is carefully identified, the responsible vessel is fully freed by sharp dissection method, then it is pushed away from the facial nerve and fully decompressed, a decompression pad of suitable size and shape is placed between the responsible vessel and the brainstem to prevent recurrence of compression, then the dura is tightly sutured and the skull is repositioned and fixed. The procedure has the advantages of exact efficacy, less bleeding, fewer complications and less pain, etc. The whole procedure is performed under a microscope and is less traumatic.
Many patients are always worried and afraid when they mention surgery, and they always think that surgery has to open up the skull – “to open up inside the brain”, so they often don’t dare to accept the surgery treatment in the end, in fact, this is a misunderstanding, surgery is not operated inside the brain, but In fact, this is a misconception, surgery is not performed inside the brain, but in the subarachnoid space between the brain tissue and the skull. Microvascular decompression is to separate the blood vessels that compress the nerve roots (the cause of the disease) from the nerve roots, then displace and fix them in a part far away from the nerve roots to achieve complete decompression of the nerve roots and obtain the purpose of treatment, so this is the treatment method for the cause of the disease.
9. Surgical results of microvascular decompression
For experienced neurosurgeons, the total efficiency of microvascular decompression for facial myospasm can be more than 95%, and there are two types of effective patients. The ineffectiveness rate is 2-3%, and the reason for ineffectiveness may be that the vessels are too closely adherent to the nerve to be separated or the responsible vessel is missed. There is a 2-3% recurrence rate after surgery, which may be caused by the new emergence of the responsible vessel and compression of the facial nerve, and the recurrence is treated effectively by surgery again.
10.Possible side effects and complications of microvascular decompression
Overall, the following complications are common in MVD for facial spasm in large number of cases at home and abroad.
(1) insignificant postoperative symptom relief 5-8%; temporary hearing impairment, tinnitus 2-3%; temporary facial palsy 1-2%; posterior group cranial nerve effects such as hoarseness, choking 1-2%.
(2) Delayed wound healing and infection 1 %; recurrence of symptoms 2-3 %
(3) For a very experienced and mature team the incidence of these complications is greatly reduced.
11, how to ensure the efficacy of reducing postoperative complications?
In recent years, some new techniques such as identification and localization of etiologic vessels, intraoperative electrophysiological monitoring, including BAEP monitoring, AMR, LSR monitoring, SEP monitoring, anatomical separation of brain fissures, microdistractionation, warm water flushing, perioperative hormone and vasodilator drugs have been applied to improve the efficacy and greatly reduce the incidence of perioperative complications. .
12.What kind of patients with facial muscle spasm are suitable for surgical treatment?
(1) Diagnosed with facial spasm affecting the quality of life.
(2) No history of facial nerve injury or facial palsy.
(3) No serious systemic disorders.
13, about the surgical cost and time of microvascular decompression
Most of them take about 2 hours to operate, but the whole anesthesia, surgery and resuscitation takes 4-5 hours, and the total cost of hospitalization is about 28,000 yuan, and the hospitalization time is 10-12 days.