Facial muscle spasm is often referred to as “eyelid jumping or corner of the mouth jumping”, mostly seen in middle-aged and elderly women. The main manifestation is paroxysmal, rhythmic twitching of the facial muscles, sometimes tonic and more violent. The twitching starts from the orbicularis oculi and gradually expands downward to the orbicularis oris muscle and facial expression muscle, which cannot be controlled at will. The symptoms may be triggered by emotional changes, work stress, excessive fatigue, or even speech. The interval between attacks varies from a few days to several months. The cause of facial myoclonus is divided into primary and secondary. Primary facial myoclonus is mostly caused by vascular compression of the facial nerve in the pontine area. Secondary cases are mostly due to some intracranial occupying lesions, such as pontocerebellar horn cholesteatoma and auditory neuroma. In the former case, microvascular decompression of the facial nerve can be considered to improve the symptoms as long as the close relationship between the nerve and blood vessels is confirmed by 3D-TOF examination. The latter requires surgical intervention to remove the lesion as soon as the occupancy is clearly identified by appropriate imaging (CT, MRI). The disappearance of twitching symptoms in patients with primary facial spasm is gradual. The disappearance of muscle twitching after a single operation reached 87.7%, and in 97% of patients the twitching was significantly reduced or disappeared during follow-up observations. The improvement of secondary facial myoclonus symptoms depends mainly on the nature of the intracranial lesion and the degree of surgical resection, and patients will have different degrees of symptom improvement after surgery. In conclusion, facial myospasm should be surgically intervened as long as there is clear vascular compression and occupancy, and simple drug control, acupuncture and physiotherapy are of little significance for symptom improvement.