What is facial spasm? Do I have facial spasm? The actual description of the patient’s performance: “My eyes twitch non-stop” “My eyelids keep jumping, sometimes my face and mouth follow” “Half of my face twitches non-stop” “My lower eyelids and the corners of my mouth twitch non-stop, my eyes are smaller and I can’t open them, I can’t sleep” “My eyelids started twitching 5 years ago, and my face and mouth started twitching 2 years ago” , “Why are the muscles on my face twitching? “In fact, the symptoms of these patients refer to one disease: idiopathic facial muscle spasm, commonly known as “face twitching”. Facial muscle spasm, also known as facial muscle twitching, hemifacial spasm, manifests as episodic, rhythmic involuntary twitching of one side of the facial muscles. Foreign epidemiological survey shows that the incidence rate is 0.78/100,000, more common in women, the ratio of men to women is 1:2, mostly seen in the middle-aged and elderly population, rarely children. Most of the spasms are unilateral, less than 1% are bilateral, generally the left side is more prevalent, and the ratio of left to right is 3:2. Clinically, the spasms mostly start from the lower eyelid on one side, and then gradually spread to the face and even the neck muscles, the spasms are intermittent at the beginning, and gradually become more frequent, especially when emotional tension, fatigue and other triggers are obvious under the muscle twitching. When the twitching is severe, it can cause facial pain and affect vision, speech and sleep. Why do I have facial muscle spasm? Long-term clinical practice has shown that facial muscle spasms are all caused by intracranial vascular compression of the facial nerve causing increased excitability of the facial nerve, and the reason as to why the vascular compression of the nerve occurs is not clear. Current practice suggests that a history of hypertension, arteriosclerosis, and posterior cranial fossa stenosis are all predisposing factors for facial myospasm and have little to do with lifestyle habits, and daily life. What is behind facial spasm? Facial myospasm is a “passionate collision” between blood vessels and facial nerves. In terms of pathogenesis, the “short-circuit theory” is now recognized by clinicians, based on the fact that the facial nerve in the intracranial section of the brainstem (REZ) is compressed by the abnormal vascularity of the vertebrobasilar system, and the facial nerve is pathologically stimulated to produce abnormal neurophysiological impulses, resulting in facial muscle twitching. This refers to the mechanism, but why one gets it is still not well understood and there is no clear preventive measure. How to treat facial muscle spasms? The current treatments for facial muscle spasm include: 1. Conservative medication: including carbamazepine, phenytoin sodium, etc. For patients with mild symptoms, it can be partially controlled. 2, local anesthetics, botulinum toxin injection: nerve block treatment is the use of botulinum toxin, ethanol drugs to block the conduction function of the facial nerve, so that the facial muscle spasm is released. After the injection, the nerve conduction is impaired and the face is immediately paralyzed or incompletely paralyzed, such facial muscle paralysis can be recovered within a few months. However, the effect is short-lived, and most patients relapse in about 3-6 months, requiring re-injection. Common complications include facial palsy, dry eyes, diplopia, swallowing difficulties, etc. 3, surgical treatment: surgical treatment currently mainly uses microvascular decompression, other surgical methods are rarely used due to poor treatment effect and high surgical complications. Microvascular decompression was pioneered by an American neurosurgeon in the late 1960s. The surgical method is to push away the blood vessel located at the root of the facial nerve (REZ area) with abnormal travel and causing compression on the facial nerve under the operating microscope to make it fixed, so that the blood vessel will not touch the facial nerve permanently, thus completely relieving the compression of the blood vessel on the root of the facial nerve, restoring the normal function of the facial nerve and making the facial muscle The twitching symptoms are relieved. With the perfection of this surgical technique, especially its minimally invasive, safety, remarkable effect, low recurrence rate and few complications, especially the ability to completely preserve the function of blood vessels and nerves, it was soon accepted by neurosurgeons all over the world and was promoted worldwide as the most effective method for treating facial muscle spasm. This minimally invasive procedure is performed under general anesthesia and is painless for the patient. The surgical incision is made in the hairline behind the affected ear, about 4-5 cm long, and a small hole of 2.5 cm in diameter is drilled in the skull.