Hemifacial Spasm is a painless neurological condition,
affecting the 7th (or "Facial") Cranial Nerve, which supplies
many of the muscles of the face. The facial muscles affected are
those involved in movements that express emotion. These
include muscles of the forehead, eye closing mechanisms, as well as
muscles around the mouth. Patients with "Hemifacial Spasm"
experience repetitive episodes of uncontrollable and involuntary
muscle spasms in the face. It frequently begins around the
eye and/or corner of the mouth and at some later date spreads to involve
the rest of the face (on the one side). This condition is the
result of a pressure injury to the "Facial Nerve"
as it leaves the Brainstem. Usually a blood vessel is the
cause of the pressure on the nerve which produces the injury
to the Myelin in a manner similar to that seen in
Trigeminal Neuralgia; however, there is NO PAIN associated
with Hemifacial Spasm.
The diagnosis becomes quite evident by the characteristic features
of the muscle contractions of one side of the face,
commonly beginning around the eye and/or one corner of the mouth.
"Thin Slice" MRI and MRA are imperative first steps in the investigation
of this condition (just as with Trigeminal Neuralgia and
The treatment of Hemifacial Spasm includes a similar operation to
the Microvascular Decompression (MVD) procedure described for
Trigeminal Neuralgia and Glossopharyngeal Neuralgia. The
Facial (or 7th cranial) Nerve is located approximately one half
inch below the Trigeminal (Fifth Cranial) Nerve. The MVD
operation is conducted through a small "Key-hole" skull opening
in a similar location as described for Trigeminal Neuralgia. In
Hemifacial Spasm the ideal treatment results in the relief of the
muscle spasm without resorting to destructive operations which produce
paralysis of the facial muscles on the one side affected.
Unfortunately, medical treatment (usually with Tegretol,
Dilantin or any other anticonvulsant drug) is very much less
effective in Hemifacial Spasm than in Trigeminal Neuralgia.
The intent of the MVD procedure is to PRESERVE MOTOR FUNCTION to
the face while RELIEVING MUSCLE SPASM.
Figure 1: Operative Photo for Right Hemifacial Spasm|
The 7th cranial nerve is compressed by a collection of arteries
(Arrow) at its junction with the Brainstem.
Figure 2: Operative Photo (same patient) The 7th Cranial Nerve
has been "decompressed" by transposing the offending arteries
away from the nerve and interposing several Ivalon (permanent)
sponges (Arrow) to protect the nerve.|
This young lady's symptoms were immediately and completely
A comprehensive review
of the entire subject of Trigeminal Neuralgia and these therapeutic
alternatives is available on this website.
Video Files: The reader is also invited to review our video files on
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This page last edited on 2/19