Twitching of the muscles of the mouth

Introduction Most patients with primary hemifacial spasm develop after middle age, and more women. At the beginning of the course of the disease, the paroxysmal involuntary convulsion of one side of the orbicularis oculi muscle gradually spreads slowly to the other facial muscles of one side of the face. The twitching of the horn muscles is most noticeable. In severe cases, the cervical stenosis of the same side may be involved. Muscle, but the frontal muscles are less involved.

Cause

The cause of hemifacial spasm is unknown, and the 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 dilatation of the vertebral-basal artery system or compression of the aneurysm. In 1967, Jannette proposed that microvascular compression of the facial nerve root is the main cause of hemifacial spasm. If the microvasculature is retracted, the hemifacial spasm can be relieved. The oppression of the posterior inferior cerebellar artery or its branches accounted for 60%, and the oppression of the anterior inferior cerebellum and vertebral artery branches accounted for 20% to 30%. Other causes are less than 1%, such as cerebellar pons tumor, inflammation, demyelination after facial neuritis, venous compression.

an examination

Related inspection

Cerebrospinal fluid calcium electromyography cerebrospinal fluid lysozyme

No abnormal performance.

Electromyography showed muscle fiber tremors and fasciculation waves. Features are:

1 array 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.

Differential diagnosis

Hemifacial spasm needs to be identified with the following diseases:

epilepsy

The facial constrictive 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 sequentially according to the cerebral cortex motor zone. Epilepsy waves can be seen on the EEG. Epilepsy, which is limited to facial muscle twitching, is rare.

Hysteric eyelid

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.

Trigeminal neuralgia

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

Choral 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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