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 common on the left side.
2, the etiology of facial muscle spasm
In terms of causative mechanism, the “nerve short circuit” theory is now recognized by clinicians, based on the fact 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 far less 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. In some cases, peripheral facial palsy can be seen due to long-term illness or botulinum toxin injection.
4.How to confirm the diagnosis of facial spasm
Patient’s medical history, typical manifestations during seizures
Imaging tests such as cranial CT and MRI to rule out the possibility of secondary intracranial tumors
No history of trauma to the skull base or facial nerve
No history of facial paralysis or paresis before onset
5.What is the treatment status of facial spasm?
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 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 and need to be re-injected. Common complications include facial palsy, dry eyes, diplopia, and difficulty swallowing. Irrecoverable facial paralysis may occur after repeated Botox injections, or resistance to Botox and ineffective.
6, 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 muscle spasm itself is not lethal or disabling, and there is no possibility of self-healing.
7.Microvascular decompression provides a new way for the treatment of 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 is performed by pushing away the blood vessels located at the root of the facial nerve with abnormal alignment and causing compression on the facial nerve under the operating microscope, and fixing them so that they do not touch the facial nerve, thus relieving the compression of the blood vessels on the root of the facial nerve, restoring the normal function of the facial nerve, and making 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.
The neurosurgery department of Beijing Sino-Japanese Friendship Hospital, Ministry of Health, introduced this technology in 1985 and took the lead in research and clinical treatment of facial spasm in China. So far, nearly 10,000 patients have been treated and satisfactory treatment results have been achieved, with a cure rate of 96% after more than 10 years of long-term follow-up, and the number of treatment cases and results are among the leading ones in China. Our treatment experience proves that the experience of the surgeon and the correct judgment and operation during the surgery have an important influence on the outcome of the surgery. Microvascular decompression for facial spasm has become one of the characteristic treatment items of neurosurgery in China-Japan Friendship Hospital.
8.How is microvascular decompression surgery performed?
General anesthesia or local anesthesia. The surgical incision is located in the hairline behind the ear, about 3 cm long, and the skin is incised and 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 vessels compressing the facial nerve are carefully identified. After the responsible vessels are fully freed by sharp stripping method, they are pushed away from the facial nerve and fully decompressed, and decompression pads of suitable size and shape are placed between the responsible vessels and the brainstem to prevent recurrence of compression. The whole operation is performed under a microscope.
9.Surgical results of microvascular decompression
For neurosurgeons with rich experience, the total efficiency of microvascular decompression surgery for facial myospasm can reach more than 98%, and the effective patients are divided into two cases: 2/3 patients have immediate disappearance of postoperative myospasm, 1/3 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 new emergence of the responsible vessel compressing the facial nerve again, and the recurrence is effectively treated by surgery again.
10. Possible side effects and complications of microvascular decompression
Delayed wound healing and infection, 1%
Insignificant symptom relief, 2-3%
Recurrence of symptoms, 2-3%
Temporary hearing impairment, tinnitus, 2-3%
Temporary facial paralysis, 2%
Intracranial infection 2%
11.What kind of patients with facial spasm are suitable for surgical treatment
Diagnosed with facial spasm
No history of facial nerve injury or facial palsy;
No serious systemic disorders
12.Problems about the cost and time of microvascular decompression surgery
Surgery time, 3-4 hours, total hospitalization cost 10000-15000 RMB, hospitalization time 10-12 days
Stable medical condition