The seventh cranial nerve travels up from the brainstem to the facial muscles. When a blood vessel or other mass compacts this facial nerve, contractions develop. Hemifacial spasms can be accompanied by trigeminal neuralgia (TN) and cause facial pain, but it is not common. Generally, TN develops from pressure on the fifth cranial nerve, the trigeminal nerve, but both conditions may need similar surgical treatments.
Some hemifacial spasms (HFS) are caused by an abnormal tissue growth pressing on the facial nerve. Removing these benign tumors can often relieve pressure on the affected facial tissue, thereby eliminating the cause of the facial contractions.
Concussions can cause eye twitches, or blepharospasms, but these are not necessarily indicative of hemifacial spasms. Although not as common, other diseases or injuries can create HFS.
Magnetic resonance imaging (MRI) allows our specialists to view the contact between a blood vessel or other presence and the facial nerve. If your seventh cranial nerve is impacted, medications, Botulinum toxin (Botox) injections or removal of the pressure caused by the artery or vein can alleviate the twitching symptoms. An MRI is often used prior to microvascular decompression surgery to pinpoint the compression.
Botox injections can temporarily halt hemifacial spasms. Since Botox treatment effects subside over time, repeated treatments are generally required. During an outpatient visit, an injection is placed just under the skin to paralyze the orbicularis oculi ( a muscle that closes the eye) and the lower facial muscle. Patients can go home the same day of surgery, and the results can last for several months. If you are considering Botox for hemifacial pain, find out more about treatment options for hemifacial pain at our trigeminal neuralgia page.
Other non-surgical treatment options may include anti-seizure medicines such Lyrica, Neurontin, Tegretol or Trileptal.
Microvascular Decompression Surgery (MVD) is a more permanent solution to your hemifacial spasms and may be recommended if medicines and Botox injections are ineffective. During microvascular decompression surgery, one of our board-certified neurosurgeons removes the compression (decompression) of the smallest (micro) blood vessel (vascular). The physician makes a small incision behind the ear on the affected side, removes some bone, enters the dura (membrane covering the brain) and places a tiny sponge-like pad between the blood vessel and the seventh nerve root. Patients are under general anesthesia for the entire procedure. After the two-hour operation, patients generally stay for another couple of days in the hospital.
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