Facial twitching

Introduction to facial muscle twitching The hemifacial spasm, also known as facial muscle twitching or hemifacial facial paralysis, refers to paroxysmal, rhythmic convulsions, spasms or tonic attacks on one facial muscle. The nervous system examination has no abnormalities except mild facial paralysis. basic knowledge The proportion of sickness: 0.001% - 0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: facial paralysis cerebrospinal fluid leakage air embolism

Facial muscle twitching cause

(1) Causes of the disease

The cause of hemifacial spasm is unknown. Abnormal nerve impulses of hemifacial spasm may be the result of pathological stimulation of certain parts of the facial nerve. These stimuli may come from arteriosclerotic dilation of the vertebral-basal artery system or compression of aneurysms. Jannette, 1967 It is suggested that the microvascular compression of the facial nerve root is the main cause of hemifacial spasm. If the microvasculature is retracted, the facial muscle spasm can be relieved, and the oppression of the posterior inferior cerebellar artery or its branches accounts for 60%. The cerebellar anterior inferior artery and the branch of the vertebral artery are compressed. Each accounted for 20% to 30%, and other reasons less than 1%, such as cerebellar pons tumor, inflammation, demyelinating degeneration after facial neuritis, venous compression.

(two) pathogenesis

The majority of hemifacial spasm patients are caused by vascular compression in the cerebellopontine angle. It is gradually accepted by people. Abnormal arterial vascular compression is within 5 mm of the facial nerve root. The facial nerve is stimulated by repeated arterial pulsations, causing nerve fibers to be compressed and compressed. The myelin sheath of the site is atrophied and degenerated, and the action current of the afferent nerve fiber is short-circuited. The trans-neuron is degenerated, and the central body loses the integration function of excitement. When the electrical excitation is superimposed to a certain extent, an explosive type is formed. Transmission, causing hemifacial spasm, compression of common cerebral inferior cerebellar artery, posterior inferior cerebellum, multiple vasospasm (complex), vertebral artery, innominate artery and vein.

In a group of 368 patients with hemifacial spasm, it was found that the chronic inflammation around the cerebellopontine angle caused the arachnoid to gradually thicken, which is another pathological basis of the hemifacial spasm. When the arterial vessels are bent, the arachnoid is blocked. When pulling close to the facial nerve root within 5 mm, the impulse of the arterial pulse can cause hemifacial spasm. In the early stage of the disease, the arachnoid adhesion is light due to the small number of degenerated fibers, so the convulsion is limited to a small area (mostly the eye rim Muscle), as the degeneration worsens, the arachnoid adhesions cause the blood vessels to approach, and the extent and extent of convulsions also increases.

Ten patients with hemifacial spasm were sampled and observed by transmission electron microscopy. Under electron microscope, the axonal degeneration was obvious. Most of the mitochondria were vacuolated, and a large number of structures similar to the Shi-lan notch appeared. Myelin sheath It is irregularly swollen and swollen. The myelin is thickened regionally and protrudes into the axon to form a "plexiform neuroma". The myelin degeneration layer is separated to form various irregular, entangled, twisted and fragmented structures. Severe cases of myelin disintegration, showing segmental demyelination, Schwann cell degeneration.

Facial muscle twitch prevention

1. The process of facial muscle twitching is long, and repeated episodes can easily affect daily life, so patients are prone to anxiety, inferiority and other psychology. Encourage patients to maintain an optimistic attitude, eliminate tension and bad emotions, establish confidence in treatment, and actively cooperate with treatment.

2. Life is regular, work and rest are combined to avoid overwork.

3. Maintain good mood and avoid mental stress, anxiety, irritability and other negative emotions.

4. Actively look for the cause and determine the surgical or medical treatment plan.

Facial muscle convulsion complications Complications, facial cerebrospinal fluid leakage, air embolism

The hemifacial spasm is slowly progressing and gradually worsening. Generally, it does not heal itself. If no treatment is given, some patients will have lateral muscle paralysis and convulsions in the late stage of the disease. Some patients with hemifacial spasm may have hearing loss. Complications such as facial paralysis and cerebrospinal fluid leakage, in order to prevent the complications of microvascular decompression surgery, first pay attention to the surgical position, avoid sitting or semi-sitting position, in order to prevent a large amount of air from entering the vein, causing multiple organ air embolism, the surgeon must Strengthen basic surgical skills training, open the mastoid air chamber to be closed in time, skillfully use the aspirator and adjust the pressure, carefully identify the vascular compression form of the facial nerve out of the brain stem area, avoid blindly electrocoagulation, separate or cut blood vessels, apply brain during surgery Monitoring of dry auditory evoked potentials, direct auditory nerve potentials, and facial nerve EMG will significantly reduce complications.

Symptoms of facial muscle twitching Common symptoms Eating tears, tinnitus, twitching, facial muscles, twitching, painful face, convulsions, twitching muscles

Most patients with primary hemifacial spasm develop after middle age, and there are many females. Most of the patients in the early stage of the disease are paroxysmal involuntary convulsions of one orbital rim muscle, gradually expanding to other facial muscles on one side of the face. The twitching of the horn muscles is most likely to be noticed. In severe cases, the platysma can be involved in the ipsilateral platysma, but the frontal muscles are less involved, and the degree of convulsions varies. It is paroxysmal, rapid, irregular convulsions, and convulsions at the beginning. It is lighter and lasts for only a few seconds. It can be extended for several minutes or longer, and the intermittent time is gradually shortened. The convulsions are gradually increased frequently. In severe cases, it is tonic, so that the ipsilateral eye can not be opened, and the mouth angle is skewed to the same side. Unable to speak, often exacerbated by fatigue, mental stress, and spontaneous exercise, but can not imitate or control their seizures on their own. A convulsion is as short as several seconds and as long as more than ten minutes. The interval is uncertain, the patient feels upset and unable to work or Learning, seriously affecting the patient's physical and mental health, most of the convulsions stop after falling into sleep, bilateral side muscle spasm is rare, if there are, often on both sides of the disease, after the side of the convulsions stop, One side recurred, and the side of the twitch was lighter on the other side, both sides were onset at the same time, and the convulsions were not reported. A small number of patients were accompanied by mild facial pain during convulsions. Individual cases may be accompanied by ipsilateral headaches and tinnitus. .

According to the strength of graded by Cohen et al.

Level 0: no flaws;

Level 1: External stimuli cause increased blinking or mild facial muscles;

Level 2: eyelids, facial muscles spontaneously flutter, no dysfunction;

Level 3: obvious, with mild dysfunction;

Grade 4: severe paralysis and dysfunction. If the patient cannot read because of the inability to keep blinking, it is difficult to walk alone. The nervous system examination has no other positive signs except facial paroxysmal convulsions. A few patients may be accompanied by the late stage of the disease. Suffering from mild muscle spasm.

Examination of facial muscle twitching

Electromyography showed muscle fiber tremors and fasciculation tremors, characterized by:

1 burst of high frequency pulses (150 to 400 per second);

2 rhythmic or irregular repeated issuance of 5 to 20 times per second, including 2 to 12 pulses per release;

3 Pulses are synchronized in all facial muscles;

4 Reverse stimulation of the facial nerve causes a typical release.

Diagnosis and differentiation of facial muscle twitching

diagnosis

According to the clinical features of the disease, paroxysmal, one side facial muscle convulsion without other positive signs of the nervous system, the diagnosis is not difficult.

Differential diagnosis

Hemifacial spasm needs to be identified with the following diseases:

Secondary facial muscle spasm

Cerebellar pons tumor or inflammation, pons tumor, brainstem encephalitis, medullary cavity, motor neuron disease, craniocerebral injury can have facial muscle twitching, but often accompanied by other cranial nerve or vertebral body damage As the side of the facial pain and facial sensation diminished, hearing impairment, contralateral or limb muscle weakness, etc., and facial muscle convulsions are only one of the symptoms, so it is not difficult to identify.

2. Epilepsy

Hemifacial confinement convulsions may also be partial sports epilepsy, but the convulsions are large, and often involve the neck, upper limbs or even the lateral limbs, or a typical Jackson episode that spreads in the cerebral cortex motor area, EEG Epilepsy is seen on the surface, and epilepsy, which is limited to facial muscle twitching, is rare.

3. Hysteria eyelids

Common in middle-aged women and female patients, more than two sides, only limited to the eyelid muscle spasm, and the facial muscles in the lower part of the face are not involved.

4. Habitual hemifacial spasm

Common in children and young adults, for short-term forced facial muscles, often bilateral, electromyogram and EEG of snoring eyelids and habitual facial muscle twitch are normal, in convulsions, myoelectric The muscle contraction wave that appears on the graph is the same as that produced during active motion.

5. Trigeminal neuralgia

For facial paroxysmal short-term severe pain, severe facial pain may be accompanied by facial muscle twitching. Although primary facial muscle twitching develops to severe, convulsions may cause facial pain for a long time, but the degree of pain is not trigeminal neuralgia. It is so intense.

6. Chorea disease and acromegaly

There may be involuntary twitching of the facial muscles, but both are bilateral, and are accompanied by similar involuntary movements of the limbs.

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