Five-Year Cure of Hemifacial Spasm

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HEMIFACIAL spasm (Fig. 1) is a condition in which paroxysms of contractions affect the muscles supplied by the facial nerve. In a review of 106 cases, Ehni and Woltman1 point out that the twitchings resemble those resulting from intermittent faradization of the nerve. The eyelids are almost always involved. The condition is usually unilateral and may occur during sleep. The patient feels no compulsion to make the movement and is unable to stop it. He cannot produce the twitchings voluntarily with anything like the speed with which they spontaneously occur. Voluntary movements may precipitate the spasms. The condition affects women more commonly than men and does not occur in children. Fourteen of Ehni and Woltman's1 patients had impaired hearing on the affected side and three had tic douloureaux. Medical treatment was of no help. These authors reported no pathologic study in their own cases, but stated that such study by other investigators either disclosed nothing to account for the spasm or revealed gross progressive lesions such as tumors or aneurysms.

The analogy between hemifacial spasm and trigeminal neuralgia is obvious from the above account. Since intracranial neurolysis of the fifth nerve relieves the painful paroxysms of trigeminal neuralgia,2 it seemed worthwhile to try a similar operation on the seventh nerve for the motor paroxysms of hemifacial spasm.

Report of a Case

A 36-year-old woman was examined in June, 1953, because of twitching of the left side of the face, which had increased steadily in severity for two years. The twitching . . .



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