Article

Many people have experienced "eyebrow twitching," often triggered by stress and fatigue, which usually resolves on its own. However, some individuals may experience twitching not only in their eyebrows but also in their mouth cornetumourseven throughout their entire face, which is not considered normal. Clinically, this condition is referred to as facial muscle spasms or facial twitching, and it is most commonly seen in middle-aged women.

The clinical manifestation involves involuntary twitching of the facial muscles on one side, which can worsen with stress or fatigue. If the eyelids intermittently contract and close, it may affect vision. Additionally, frequent facial muscle spasms can cause significant distress in normal social interactions and work.

Facial muscle spasms are typically diagnosed and treated by neurologists or neurosurgeons. They will check for any associated neurological deficits, rule out conditions such as blepharospasm, abnormal muscle tone, or even intracranial lesions. If necessary, a magnetic resonance imaging (MRI) scan of the brain may be arranged to exclude intracranial tumours or vascular disorders.

Facial muscle spasms are primarily caused by compression of the facial nerve root as it exits the brainstem, often due to nearby abnormally positioned blood vessels, such as the vertebral or cerebellar arteries. This compression leads to damage of the nerve sheath and results in short-circuiting between nerve fibres, causing the spasms.

Pharmacological Treatment
Pharmacological treatments include antiepileptic drugs or sedatives, but most have limited efficacy.

Botulinum Toxin Injections
A commonly used and effective treatment method involves injecting botulinum toxin into the muscles affected by spasms, including small doses in multiple sites around the eyelids and mouth. The effects typically last for about three months, requiring regular injections, and the long-term efficacy may diminish.

Surgical Treatment
Microvascular decompression surgery is a definitive treatment for facial muscle spasms. It is mainly indicated for patients with severe symptoms who do not respond to botulinum toxin injections or who prefer not to undergo repeated treatments.
The surgical procedure involves a craniotomy behind the ear, requiring an incision of about 4-5 centimetres. Under a microscope, the blood vessels that are abnormally close to and compressing the facial nerve root are moved aside. A material called Teflon is then placed between the vessels and the nerve to keep them permanently separated, alleviating the compression. Neural monitoring during the surgery helps reduce complications and improve the success rate.

Summary

Mild facial muscle spasms can be monitored regularly. If symptoms significantly impact daily life, botulinum toxin injections or microvascular decompression surgery may be considered for treatment.