Facial muscle spasm
1.What is facial muscle spasm
Facial muscle spasm, also known as facial muscle twitching, lateral facial muscle spasm, is customarily referred to as “facial twitching” and is characterized by episodic, rhythmic involuntary twitching of one side of the facial muscles. The twitching usually starts from one eyelid first, and then gradually worsens and extends to the face and corners of the mouth, or in severe cases, to the ipsilateral neck. According to statistics, the prevalence of this disease accounts for 6/400,000 to 180/100,000.
2, the 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 in severe cases, the ipsilateral neck muscles may be involved, and the symptoms may be aggravated by emotional stress and disappear during sleep, often accompanied by headache and tinnitus. There are no positive neurological signs. In some cases, peripheral facial paralysis can be seen due to long-term illness or injection of botulinum toxin.
3. Causes of facial muscle spasm
At present, the more recognized cause is that the intracranial facial nerve is compressed by the abnormal traveling vessels of the vertebrobasilar artery system at the emitting part of 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%.
4, the main harm of facial muscle spasm
Facial muscle spasm affects the patient’s appearance and causes inconvenience to daily life and work. Irrecoverable facial paralysis can occur after repeated incorrect treatment. Facial spasm itself is not lethal or disabling, and there is no possibility of self-healing.
5.How to confirm the diagnosis of facial spasm
Patient’s medical history, typical manifestations during seizures.
Imaging examinations such as cranial CT and MRI to exclude the possibility of secondary intracranial tumors.
No history of trauma to the skull base or facial facial nerve.
No history of facial paralysis or paralysis before the onset of the disease.
6, the current status of treatment of facial spasm
For facial spasm, there are no special drugs. Drugs, acupuncture, physiotherapy and other treatment methods are definitely ineffective. Nerve block treatment is the use of botulinum toxin and other drug injections to block the conduction function of the facial nerve, so that the facial muscle spasm is lifted. After the injection, the nerve conduction is blocked and the facial muscle becomes paralyzed or incompletely paralyzed immediately, and this facial muscle paralysis can be recovered 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 and need to be re-injected. Common complications include facial palsy, dry eyes, diplopia, and difficulty swallowing. Irrecoverable facial palsy can occur after repeated Botox injections, or resistance to Botox can occur and become ineffective.
Microvascular decompression is the only known cure for facial spasm. Since the 1980s, this surgical approach has been the preferred method of treatment for facial myasthenia internationally. The procedure 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 in their course and cause compression of the facial nerve, so that the blood vessels do not touch the facial nerve, thereby 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 promoted 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. The serious complications of this procedure are less than 1/1000. Therefore, it is a safe surgery.
7. Steps of microvascular decompression
General anesthesia or local anesthesia. The surgical incision is located in the hairline behind the ear, about 3 cm long. After cutting the skin, a microbony hole (the size of a locking hole, usually 1.5 cm in diameter) is drilled in the skull to enter the skull. The facial nerve root is explored, and the responsible vessel compressing the facial nerve is carefully identified. After the responsible vessel is fully freed by sharp dissection method, it is pushed away from the facial nerve and fully decompressed, and a decompression pad of suitable size and shape is placed between the responsible vessel and the brainstem to prevent recurrence of compression. The entire surgery is performed under a microscope.
Surgical incision The blood vessel found to be compressing the facial nerve during the operation The compressing blood vessel is opened with Teflon cotton pad
8.Surgical results of microvascular decompression
The total efficiency of microvascular decompression surgery for facial myospasm in our hospital is more than 98%, and there are two types of effective patients: 2/3 of patients have immediate disappearance of postoperative myospasm, and 1/3 of patients still have postoperative myospasm, but it will disappear within 2 weeks-12 months, which is called delayed cure. The ineffectiveness rate is 2-3%. The ineffectiveness may be due to tight adhesion of the vessel to the nerve that cannot be separated or the missed responsible vessel. There is a 2-3% recurrence rate after surgery, which may be caused by the newly emerged responsible vessel compressing the facial nerve again, and the recurrence is treated effectively by surgery again.
9.What kind of patients with facial spasm are suitable for surgical treatment
Confirmed diagnosis of facial spasm.
No history of facial nerve injury or facial palsy.
No serious systemic disorders.
10.The situation of neurosurgery in our hospital
Since the introduction of this technology in 1990, our neurosurgery department has been the first to carry out research and clinical treatment of facial spasm in Jinan area. Under the leadership of Dr. Ge Mingxu, the head of the department, hundreds of patients have been treated so far and satisfactory treatment results have been achieved. Our treatment experience proves that microvascular decompression for facial spasm has good surgical effect and low complications, and has become one of the characteristic treatment items of neurosurgery in our hospital.
11.Surgical cost and time of microvascular decompression
Operation time 60-90 minutes Total hospitalization cost 10000 RMB Hospitalization time 10-12 days.