What Is a Hemifacial Spasm?

A hemifacial spasm is a nervous system disorder that causes involuntary twitching on one side of the face. The spasm can cause intermittent twitching of the eyelid muscle, along with forced closure of the eye. If left untreated, hemifacial spasms can spread to the lower face and disrupt all muscles on one side of the face. 

Dr. Babak Azizzadeh of The Facial Paralysis Institute is world-renowned for his facial plastic and reconstructive surgery and head and neck surgery expertise. He applies his expertise to treatment of hemifacial spasms and works with patients to uncover the root cause of any facial paralysis symptoms. In doing so, Dr. Azizzadeh helps patients correct hemifacial spasms and other facial paralysis conditions and find ways to prevent them from recurring.

Hemifacial Spasms Explained

Hemifacial spasms can affect men and women but tend to occur more frequently in middle-aged or elderly women, according to the National Institute of Neurological Disorders and Stroke. They also tend to be more common among the Asian population than other ethnic groups. 

A hemifacial spasm can initially cause eyelid twitching. This can escalate and make it tough for an individual to open and close the eye. It can reach a point where the mouth gets pulled to one side of the face, too. In this instance, hemifacial spasms can extend across the affected side of the face.   

What Causes a Hemifacial Spasm?

Hemifacial spasm causes vary. A hemifacial spasm can occur due to a blood vessel that comes into contact with a facial nerve. In addition, it can happen as a result of a facial nerve injury or tumor. 

There have been instances reported in which hemifacial spasms are related to stress, fatigue, anxiety, and moving muscles in the face. Rarely, there are instances in which there is no identifiable cause of a hemifacial spasm.

Hemifacial Spasm Symptoms

Common hemifacial spasm symptoms include muscle contractions or twitching on one side of the face. The contractions or twitching may be uncontrollable and painless. And these symptoms can start at the eyelid and move to the cheek and mouth on the impacted side of the face. 

Hemifacial spasm symptoms can crop up at any time. They often disappear on their own. However, the symptoms can last for many months or years. 

There may be instances in which hemifacial spasms affect both sides of the face as well. In these instances, facial twitching will not occur on both sides of the face simultaneously.  

Hemifacial Spasm Diagnosis

People who experience hemifacial spasms can undergo a physical exam, magnetic resonance imaging (MRI) scan, and other tests to diagnose their condition. 

A physical exam can provide an excellent starting point for a hemifacial spasm diagnosis. It can be used to determine if a patient is dealing with a spasm, as well as its severity. 

Along with a physical exam, an MRI can be used to diagnose hemifacial spasms. An MRI provides detailed images of a patient’s head and offers insights into potential hemifacial spasm causes.

A doctor may diagnose hemifacial spasms without comprehensive testing, too. The doctor can assess their patient’s symptoms and their severity. From here, the doctor may order an imaging test to verify their patient is dealing with hemifacial spasms. Or, the doctor may move forward with hemifacial spasm diagnosis and treatment. 

Hemifacial Spasm Treatment

To address hemifacial spasms, patients can receive Botox injections or undergo surgery.

If a patient is coping with a hemifacial spasm, Botox can be injected into affected areas of the face to temporarily alleviate twitching. Botox relaxes unwanted muscle movements in the impacted side of a patient’s face, thereby reducing tension in areas that are hyperactive due to hemifacial spasms.

Microvascular decompression surgery is also available to treat hemifacial spasms. This specialized surgical procedure involves making a small incision in the skull behind a patient’s ear. Then, the blood vessel responsible for compressing the facial nerve is identified, and it is moved away from the nerve. A tiny “pad” is next inserted in the space between the facial nerve and blood vessel, which protects the nerve and stops nerve irritation that contributes to hemifacial spasms.

Selective neurolysis can be used to treat hemifacial spasms as well. During selective neurolysis, intraoperative electromyography (EMG) is used to map out the facial nerves. Next, the platysma muscle that pulls the corner of the mouth down is released, resulting in spontaneous facial reanimation.

What Is a Better Hemifacial Spasm Treatment: Botox or Surgery?

The ideal treatment for hemifacial spasms varies. But, by meeting with Dr. Azizzadeh, a patient can learn about Botox and surgical treatments for hemifacial spasms. He or she can then decide the best course of action to treat their hemifacial spasm symptoms. 

Dr. Azizzadeh recognizes that hemifacial spasms can range from mild to severe. At first, Dr. Azizzadeh evaluates his patient’s hemifacial spasm symptoms and finds out how long they have been occurring. He also requests myriad testing as he tries to find out why these symptoms are happening and what can be done to treat them. 

If a patient is diagnosed with hemifacial spasms, Dr. Azizzadeh crafts a custom treatment plan for him or her. In certain instances, Dr. Azizzadeh recommends Botox. Dr. Azizzadeh may choose Botox over surgery if he believes his patient’s hemifacial spasms can be treated without requiring this individual to go under the knife. Conversely, Dr. Azizzadeh may prefer surgery over Botox if he finds his patient’s hemifacial spasms severely disrupt their facial appearance or ability to move their facial muscles.  

Regardless of his recommendation, Dr. Azizzadeh verifies that his patient knows what to expect during treatment. He confirms that his patient’s treatment concerns and questions are addressed. Dr. Azizzadeh even verifies that his patient can treat hemifacial spasms and other facial paralysis conditions at the same time. 

Can Hemifacial Spasms and Moebius Syndrome Be Treated at the Same Time? 

The ideal treatment for hemifacial spasms depends on the patient. If a patient is coping with hemifacial spasms, Dr. Azizzadeh performs a full evaluation, then offers a personalized treatment recommendation. Comparatively, if a patient is coping with Moebius syndrome, Dr. Azizzadeh tailors his treatment plan to his patient’s symptoms.

Moebius syndrome is a rare neurological condition that can affect an individual’s facial appearance. Like hemifacial spasms, Moebius syndrome can make it tough to fully open and close the eyes. Moebius syndrome patients can also have trouble smiling, frowning, and making other facial expressions, as well as experience speech problems and misaligned teeth.

The cause of Moebius syndrome is unknown, but some research suggests the condition can occur due to environmental and genetic factors. Regardless of why Moebius syndrome occurs, a patient who experiences any signs of the condition should explore treatment options right away.

There is no cure for Moebius syndrome, but surgical options are available to help patients manage their symptoms. A temporalis tendon transfer is one such option, and it can improve facial movement in Moebius syndrome patients.

A temporalis transfer involves taking the temporalis muscle from a patient’s scalp and transferring it into a patient’s mouth. Following the procedure, a patient undergoes physical therapy to learn how to move the mouth to manage facial expressions and other facial movements.

Also, a bilateral gracilis muscle transfer to masseter nerve procedure can be used to treat Moebius syndrome symptoms. The procedure involves transferring the gracilis muscle from a patient’s inner thigh to the face. After a bilateral gracilis muscle transfer to masseter nerve procedure, a patient requires several months to improve facial movement and achieve a natural-looking smile.

Bilateral selective neurolysis is another surgery that can be considered for Moebius syndrome patients. The surgery was pioneered by Dr. Azizzadeh and has limited downtime in comparison to other Moebius syndrome treatment options. Upon completion, bilateral selective neurolysis can help a Moebius syndrome patient enhance facial muscle coordination.

Finally, eyelid reconstruction can be used to help Moebius syndrome patients dealing with eyelid closure issues. Various eyelid reconstruction procedures can be considered, including gold weights and eyelid springs. An eyelid reconstruction procedure can be used to improve a Moebius syndrome patient’s vision and tighten the eyelid muscles.

Choose the Best Hemifacial Spasm Treatment

Patients who experience hemifacial spasms, Moebius syndrome, or other facial paralysis conditions can meet with Dr. Azizzadeh to review treatment options. Dr. Azizzadeh is Harvard-trained, and he understands the right treatment for facial paralysis symptoms depends on a variety of factors. Therefore, Dr. Azizzadeh learns about a patient and considers any treatment options that are safe and can help the patient achieve a balanced facial appearance and make natural facial expressions.

Ultimately, there is no need to wait to explore treatment options for facial paralysis symptoms. Dr. Azizzadeh is available to consult with a patient, perform an evaluation, and examine treatment options. He can also respond to any facial paralysis treatment concerns and questions and help a patient make an informed treatment decision. To learn more about facial paralysis treatment options or to schedule a consultation with Dr. Azizzadeh, please contact us online or call us today at (310) 893-6192.

---