A hemifacial spasm is a nervous system disorder in which the muscles on one side of the face start to twitch involuntarily. Hemifacial spasm may be caused by a blood vessel touching a facial nerve, a facial nerve injury or a tumor, or it may not have a cause.In a majority of the cases, the spasm starts near the eye and progresses down the face over time. Sometimes, it starts near the chin and progresses upward. The twitching is usually not painful, but it can be embarrassing and interfere with normal expression and vision.Hemifacial spasm can be caused by injury to the facial nerve, a tumor or blood vessel compressing the nerve, or Bell’s palsy. The most common cause is compression of the facial nerve by the anterior inferior cerebella artery where the nerve begins at your brainstem. The compression causes the nerve to misfire making your facial muscles contract. The most important symptom is the twitching that usually begins around the eye. At first the twitching spasms may come and go. Gradually the spasms may become worse and the spasm may become permanent. The left side is more often affected than the right. The twitches may spread to involve other muscles on the same side of the face. The mouth and jaw are often involved. The corner of the mouth can become pulled up by permanent spasm. Some people also hear a clicking sound on the side that is affected when the spasm comes. In some cases the spasms may affect vision as well.
The diagnosis of a Hemifacial Spasm will typically include a thorough examination of the medical history of the patient.This will be followed by a physical examination where the doctors will check for signs of hemifacial spasm. The doctor may order imaging tests to diagnose the condition, determine the cause and develop the most appropriate treatment for the condition.
Depending on the extent of the condition, the treatment might include one or more of the following components:
- Botulinum injections: Your doctor may inject botox(botulinum toxin type A or type B) into the affected muscles, which temporarily paralyzes those muscles. These will need to be followed by additional treatments every few months.
- Medication:Clonazepam and diazepam, can relieve hemifacial spasm in some cases.
- Microvascular decompression surgery: An opening in the skull is made which opens the covering of the brain (dura) to expose the facial nerve as it leaves the brainstem. The surgeon locates the blood vessel pressing on or irritating the facial nerve and puts a sponge-like material between the nerve and blood vessel, removing the pressure on the nerve.
The doctors at GIN make use of the best available technology and procedures to manage the condition and mitigate its symptoms.
The doctor may order imaging tests to diagnose your condition, determine the cause of your condition and develop the most appropriate treatment for your condition.
A magnetic resonance imaging (MRI) test is usually prescribed.It uses powerful magnets and radio waves to create detailed images of your head and determine the cause of your hemifacial spasm. The doctor may inject a contrast dye into a blood vessel (magnetic resonance angiogram) to look for any abnormal blood vessel that may be irritating the facial nerve.