Hemifacial spasm: evaluation and management options.

Abstract

Vascular loop compression syndrome of the facial nerve is well documented as a cause of hemifacial spasm (HFS). These unilateral synchronous contractions of facial musculature are a cause of cosmetic defomity, social embarrassment and often mild facial weakness in longstanding cases. However, other documented causes of HFS include tumor infiltration, aneurysms, primary congenital cholesteatoma, herpes zoster oticus and primary facial nerve neuromas. Therefore, a knowledgeable diagnostic evaluation is necessary to avoid pitfalls of improper management. Advances in imaging techniques that aid in uncovering the etiology of HFS are reviewed. We now combine three modalities — computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) — to avoid pitfalls in the management of this uncommon disabling condition. We also present 11 cases of hemifacial spasm; five patients did not have vascular loop compression as the underlying cause for their spasm.