I. Overview Facial spasm (HFS) is a recurrent paroxysmal, involuntary twitching of one or both facial muscles (orbicularis oculi, expression muscles, orbicularis oris), which is aggravated by emotion or tension, and in severe cases, there may be difficulty in opening the eyes, distorted corners of the mouth and twitch-like murmur in the ear. It is more common in middle-aged and elderly people, with slightly more women than men, and the age of onset is trending younger. Although most of the facial muscle spasms are located on one side, bilateral facial muscle spasms are not uncommon. The diagnosis mainly depends on the characteristic clinical manifestations, and the related auxiliary examinations include: electrophysiological examination, imaging examination, and carbamazepine treatment test. Electrophysiological examinations include electromyography (EMG) and abnormal muscle response (AMR) or lateral spread response (LSR) test. Imaging tests include CT and MRI to identify intracranial lesions that may be causing the facial spasm. Patients with facial myasthenia are generally effective with carbamazepine treatment at the beginning of the disease (a small number of patients may become ineffective). 1. Bilateral blepharospasm: it is characterized by recurrent episodes of involuntary eye closure of both eyelids, often with simultaneous onset of bilateral eyelids. 2, Meijer syndrome: patients often start with recurrent episodes of involuntary eye closure on both eyelids, but with the prolongation of the disease, there will gradually be involuntary twitching of the muscles below the eye fissures, manifesting as involuntary abnormal movements on the sides of both sides, and as the disease worsens, the range of muscle spasms will gradually expand downward, even involving the muscles of the neck, extremities and trunk. 3. Bite muscle spasm: It is the spasm of unilateral or bilateral masticatory muscles, and patients may have different degrees of upper and lower jaw bite disorder, teeth grinding and mouth opening difficulties, and trigeminal nerve motor branch lesion is one of the possible causes. 4. Facial palsy sequelae: manifested as restricted activity of ipsilateral facial expression muscles, involuntary twitching of the ipsilateral corners of the mouth and conjoined movement of the corners of the mouth and eyelids, which can be identified based on the exact history of facial palsy. Treatment 1.Medication: Commonly used drugs include carbamazepine, oxcarbazepine and Valium, etc. Alternative drugs are phenytoin sodium, clonidine, baclofen, topiramate, gabapentin and haloperidol, etc. 2, botulinum toxin injection: commonly used drugs for injection of botulinum toxin type A. 3, microvascular decompression: indications include: the diagnosis of primary facial muscle spasm is clear, secondary lesions are ruled out by cranial CT or MRI; facial muscle spasm symptoms are serious, affecting daily life and work, and the patient is strongly willing to operate; patients treated with drugs or botulinum toxin should be actively operated if there is poor efficacy, ineffectiveness, drug allergy or toxic side effects; patients who relapse after MVD surgery can be operated again; patients who are ineffective after MVD surgery should be operated again if they think that the first time. Patients with ineffective MVD can be considered for early reoperation if the first surgical decompression is considered inadequate and the postoperative AMR test is positive. Common complications include: cerebral neurological dysfunction, cerebellar and brainstem injury, cerebrospinal fluid leakage, low intracranial pressure syndrome, other complications, etc.