Crooked mouth, unable to speak

Introduction Most patients with hemifacial spasm develop after middle age, and women are slightly more. It starts from one side of the eye and gradually extends to the mouth and all facial muscles. The frontal muscles are less affected. In severe cases, the ipsilateral platysma can be involved. For paroxysmal, rapid, irregular convulsions. At the beginning, the convulsions are lighter for a few seconds, and then gradually extended for up to 5 minutes or longer, while the interval is gradually shortened and the convulsions become more serious. Severe cases are tonic, so that the ipsilateral eye can not be opened, the mouth angle is severely skewed to the same side, unable to speak.

Cause

According to the cause, the disease can be divided into two types: special and secondary.

1, secondary symptoms are also known as symptomatic hemifacial spasm, in the entire channel of the cerebral cortex to the peripheral branch of the facial nerve, any compression irritant lesions can induce the disease. Clinically common such as middle ear mastoid inflammation and tumors, space-occupying lesions of cerebellopontine angle (cholesteatoma and acoustic neuroma) and encephalitis, arachnoiditis, multiple sclerosis, Paget's disease and cranial depression.

2, those who can not find the incentives, collectively referred to as idiopathic sputum, accounting for about 2 / 3 of the total number of cases. In 1966, Jannetta proposed that the facial nerve roots (REZ) are compressed by the running small arteries, which constitute the facial muscles. The main cause of sputum, and the use of microvascular decompression treatment, achieved satisfactory results.

an examination

Related inspection

EMG heart sound map examination

Electroencephalography and electromyography should be performed routinely. If necessary, mastoid, skull X-ray, head CT and MRI should be performed to exclude mastoid and skull diseases.

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.

Facial paralysis

In the past, there was a clear history of facial paralysis. Due to the incomplete recovery of facial paralysis, the axonal regeneration was caused by confusion. The affected side left different degrees of facial muscle weakness and paralysis.

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