Receiving the correct diagnosis of hemifacial spasm can feel like both a blessing and a curse. You now know what has been causing you all of the issues you’ve been experiencing, but are now faced with choosing a treatment. It’s important to remember you’re not alone in this – working with your doctor and neurosurgeon, you can find the best treatment options for your hemifacial spasm.
What Is Hemifacial Spasm?
Frequently referred to as a facial twitch, hemifacial spasm is a condition in which one side of your face experiences a frequent and involuntary twitch. It can be mild, affecting only the area around one eye, but can become more widespread and start showing up in other parts of your face.
Eventually, you will experience more intense symptoms. The muscle spasms will last for longer periods of time, resulting in facial distortions such as a pronounced grimace or “smushed” appearance around your eye and mouth.
The cause of hemifacial spasm is similar to that of other conditions, such as trigeminal neuralgia. It is often the result of a blood vessel such as an artery or vein pushing against facial nerves where the structures leave the brainstem. This causes the nerve to erroneously send out impulses that cause the muscle spasms.
Successfully Treating Hemifacial Spasm
There is currently no cure for hemifacial spasm, but a number of treatments have proven effective in resolving the symptoms.
Botox Injections for Hemifacial Spasm
Botox can be used to temporarily paralyze the muscles that are responding to the misfiring nerve impulses. Your doctor can help you decide if this is a viable option for your hemifacial spasm. It’s important to note that you will need to have these injections done approximately every three months to maintain a good comfort level and prevent the telltale “grimace” that occurs with this condition. Unfortunately, many people find that these injections become less effective over time, with some even experiencing permanent paralysis or atrophy in the affected facial muscles.
Microvascular Decompression Surgery
While medications or Botox may work for some, you may choose to seek a more permanent means of resolving your hemifacial spasm. A surgical procedure known as Microvascular Decompression (MVD) has proven to be effective in treating this condition.
Microvascular decompression is only recommended for those who are in good health and can withstand general anesthesia. You will also need to have a specialized imaging study done to isolate the nerve-vessel compression prior to surgery. This imaging technique is known as a FIESTA-MRI, and it allows your neurosurgeon to clearly see where the nerve is being compressed by a vein or artery.
When it’s been established that you are ready for MVD, you will be scheduled for surgery. The morning of surgery, you will arrive at the hospital. You’ll be admitted and fill out any paperwork necessary for the procedure. You’ll then be taken back to the prep area. You’ll meet your surgeon and anesthesiologist, then will be prepared to go to the operating room. Once under general anesthesia, a specialist will perform a technique called neurophysiological monitoring in order to be sure that your hearing and brainstem function remain safe and protected throughout the operation. Once this is set up, your doctor will begin your surgery.
A small piece of bone about the size of a quarter will be removed about an inch behind your ear. This will give your surgeon access to the facial nerve and the offending blood vessel. Using special instruments such as a surgical microscope, the surgeon will locate the nerve and vessel. Your surgeon will then place a tiny Teflon sponge between the nerve and blood vessel. This creates a buffering cushion that prevents the vein or artery from being able to touch and irritate the nerve. Often times, the twitching stops during the placement of the sponge and this “calming” can be detected through the same neurophysiological monitoring that was set up at the start of your surgery. Once finished, your surgeon will use a bone substitute to close your skull, then will suture the skin into place and you’ll be taken to the recovery area.
Once you’ve woken up from anesthesia and your vitals are stable, you’ll be moved to ICU for overnight observation. Here your pain medications will be adjusted and you will begin your recovery phase. You can expect to go home after one to three days. Most people experience immediate relief from their symptoms but it may take a few days to notice results if the nerve was particularly irritated.
When you return home, you’ll need to get plenty of rest. Make sure you have someone to help you with daily chores and other duties. Eating a well-balanced, nutritious diet will help nourish your body and support proper healing. Be sure to take your pain medications on time to prevent any discomfort.
By the end of week one, you’ll be feeling better. You’ll have more energy and should be taking short walks regularly to encourage blood flow throughout your body. You still need to rest whenever you feel tired.
Weeks two and three you’ll be able to increase your activity level somewhat. Many people are able to return to light-duty jobs (such as desk work) by week two. Continue to follow your doctor’s orders and don’t overdo it.
Between weeks four and six you will be returning to your doctor’s office for a follow-up. Your surgeon will assess you to make sure everything is going as planned with the healing process. You may also be released to go back to a job that requires slightly more strenuous activities such as lifting.
You can expect a full recovery from surgery by about 6 months after surgery. There is around a 90 percent success rate in the complete disappearance of symptoms when you undergo microvascular decompression surgery.
Regardless of whatever treatment you decide on, be sure to work closely with your neurologist and neurosurgeon to make sure it’s the right one for you. You deserve to live a life free of the pain and discomfort that is caused by hemifacial spasm.
