How to treat facial cramps?

Sometimes we see some older people in our daily lives, their faces twitch involuntarily. This is a manifestation of facial muscle spasm, which we often call facial cramps. If facial cramps are occasional, it may be caused by excessive social pressure or too much mental worry, but if they are frequent, it may be a symptom and needs timely treatment.

1: Except for drugs such as phenytoin sodium or carbamazepine, which may be effective for some mild patients, general central sedatives, inhibitors and hormones have no significant therapeutic effect. In the past, procaine, anhydrous alcohol or 5% phenol glycerol were often used for injection at the papilla to cause temporary necrosis and degeneration of nerve fibers and reduce the conduction of abnormal excitement. The injection volume was 0.3-0.5ml per time, so as to achieve mild facial paralysis. Too much dosage will produce permanent facial paralysis, and too little dosage will still relapse after 3-5 months. It is rarely used now.

2: Injection method: The patient lies on his side, and the area around the mastoid process under the affected ear is disinfected with conventional iodine and alcohol. At the junction of the cartilage at the bottom of the external auditory canal and the front edge of the mastoid process, a 20-21 gauge needle is connected to a 2ml syringe, with the needle tip pointing forward, inner and upward, at a 30-degree angle to the horizontal line of the skull base. After 3 cm, it enters a depression. First, 1ml of 1% procaine is injected, and the needle is not pulled out. Observe for 1-2 minutes to see if facial paralysis occurs. If facial paralysis occurs, it means that the nerve trunk has been pierced. Then connect an empty needle with hydroalcohol and inject 0.3-0.5ml of alcohol or phenol glycerol. Obvious facial paralysis will occur and the spasm will disappear. After half a year, most paralysis can be gradually recovered, and spasms will recur in about 2/3 of patients.

1: Use the radio frequency cannula needle to pierce the mastoid foramen according to the above method, and use the electric couple principle to generate heat energy between nerve fibers through radio waves. The temperature is 65-70℃. Under the monitoring of the facial nerve function monitor, the temperature is controlled to make the nerves heat-coagulate and denature, so as to reduce the nerve fibers that conduct abnormal impulses. Facial paralysis will also occur after the operation. In the process of gradual recovery within 1-2 years, the old disease will recur. Otherwise, the electric heat is excessive, and although the spasm can be long-term, it will be replaced by permanent facial paralysis.

1: Compression and branch resection of the facial nerve trunk Under local anesthesia, make an incision below the mastoid foramen, find the main trunk of the nerve, and use a vascular clamp to compress the nerve trunk. The compression force should be properly controlled. If it is mild, it will relapse in a short period of time, and if it is severe, permanent facial paralysis will remain. If the distal branch is found, the main responsible nerve branch for spasm is found under electrical stimulation, and selective resection is performed. Although the effect is better than compression surgery, mild facial paralysis will still occur after the operation, and recurrence will occur 1 to 2 years later.

2: Facial nerve decompression is to grind open the bone canal where the facial nerve emerges from the skull to reduce pressure. It was first used by Proud in 1953. Under local anesthesia, the mastoid is chiseled open, and the horizontal and vertical bone canals of the facial nerve are completely removed with an electric drill. The nerve sheath is cut longitudinally to reduce pressure on the nerve fibers. In 1972, Pulec believed that the range of decompression in the mastoid alone was too small, and the top of the internal auditory canal and the labyrinth should be completely grinded open to reduce pressure. During the operation, pathological changes in the nerves were found, such as nerve edema, diffuse hypertrophy, and nerve sheath fiber contraction, which were inconsistent with the cause of the disease, but some patients were indeed cured after the operation. In 1965, Cawthorne reported 13 cases of surgery without any abnormalities. Decompression surgery is relatively complicated, especially full-segment decompression surgery, which is not only difficult but also has certain risks. It is also worth discussing whether the so-called therapeutic effect is due to the trauma of the face during the operation rather than the decompression effect.

3: Vertical nerve combing Scoville (1965) used the above method to grind open the vertical facial nerve bone canal, and then used a fiber knife to longitudinally cut the vertical segment 1 cm and separated it with a silicone film. The purpose was to cut off the crossed nerve fibers to reduce abnormal impulse conduction. The disadvantage is that it is difficult to accurately achieve the degree of neither obvious facial paralysis nor spasm.

4: The facial nerve wire ligation technique was designed by the author. The facial nerve trunk is ligated with a 1mm diameter wire to create permanent compression. The degree of ligation can be adjusted at will. The method is simple and reliable. It is suitable for the elderly and weak who are not suitable for craniotomy and exploration, and is more suitable for general primary care units. Under local anesthesia, an arc-shaped incision is made along the mandibular angle behind the earlobe to separate the posterior edge of the parotid gland, find the main trunk of the facial nerve, take a stainless steel wire and penetrate it through the bone cartilage in front of the mastoid, tighten it and fix it as a fulcrum, then wrap it around the nerve trunk and ligature it. While ligating, observe the facial muscle activity until the spasm stops and mild facial paralysis occurs. Generally, it is appropriate to close the palpebral fissure to no more than 1-2mm. The wire is left outside the incision and is not cut off for the time being. The next morning, observe whether the spasm recurs, and then adjust the pressure for the last time, cut off the excess wire, and bury it under the skin. If there is a recurrence after the operation, the incision can be opened, the tail of the wire can be found, and then ligature can be performed. If the facial paralysis does not recover for a long time, the wire can also be released. The disadvantage of this method is that there will definitely be facial paralysis for 3 to 6 months after the operation, and the recurrence rate is high, reaching 30%.

There are three major treatment methods. You can treat yourself according to the above treatment methods to find out the cause of your illness. In this way, you can cure it quickly by taking the right medicine. In normal times, combine exercise and medicine, which is the so-called medicine and physical treatment. You should often move your facial muscles, so that you can get better quickly. I hope this can help everyone.