Facial Myokymia: Causes, Symptoms, and Treatment Options

Continued inquiry: Involuntary twitching of the left cheek?

Dear Dr.
Gao,
Thank you very much for your response.
If the second reason is correct, that the facial nerve was injured due to the cosmetic surgery and subsequent impact, could my symptoms be due to abnormal adhesions between the facial nerve and other tissues? Or could it be caused by scar tissue or vascular compression? (If the nerve were severed, I should feel numbness, right? But I do not experience any numbness.) What treatment options are available, and is there a definitive solution? Is it possible to use a facial nerve detector and then surgically release the injured or compressed nerve? I am currently in the United States and am unsure how to proceed.
I look forward to your reply, and thank you very much!
Best regards,
An An
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Two years ago, I underwent cosmetic surgery to elevate my cheeks (details provided by the doctor are attached).
After the surgery, my cheeks were very swollen, and before the swelling subsided, my left cheek was accidentally hit hard by my one-year-old daughter.
Once the swelling on my left cheek went down (about 3-6 months later), I began to experience involuntary movements in my left cheek.
It is not a rapid twitch, and it is not visible on the surface, but I can distinctly feel a sensation as if a worm is slowly moving back and forth inside my flesh.
Initially, the movement was quite pronounced, but it gradually decreased in amplitude, although it has remained constant for over a year now.
My plastic surgeon informed me that this is due to hypersensitivity of the nerve, causing involuntary discharges, and advised me to massage my cheek to desensitize it.
I have just started massaging and am unsure if it will be effective.
Although it does not cause any harm, it has made me quite anxious and led to some physical symptoms, so I am eager to know if there is a way to completely resolve this issue.
I look forward to your response.
Thank you!
---
Operation Summary:
Pre-Op Diagnosis: Aging face
Operation Method: 1.
Endoscopic Temporal Lift 2.
Endoscopic Midface Lift with Endotine Midface Device Fixation
Dissection Planes: Dissection over the temporal area was performed under the superficial temporal fascia (Ramirez's method), extending beyond the upper margin of the zygomatic arch (down to the midface), and the dissection was carried down to the subperiosteal plane.
All dissection was performed under endoscopic guidance.
Fixation: The superficial temporal fascia in the temporal area was lifted and fixed to the deep temporal fascia at a higher position with sutures, while the tail of the Endotine Midface device was also lifted and fixed to the deep temporal fascia around the temporal incision area.
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Response Date: 2014/06/29
Doctor: Dr.
Gao, Taichung Hospital, Neurology
According to the symptoms described, it resembles facial myokymia, which is characterized by involuntary muscle contractions.
This can range from benign nerve hyperexcitability (like eyelid twitching) to involuntary discharges from facial nerve injury, or specific demyelinating lesions in the brainstem.
The first type usually resolves on its own within days to weeks and may recur intermittently.
The second and third types require a detailed examination by a neurologist to assess facial and brainstem-related nerve function, and further arrangements for neurophysiological or imaging studies may be necessary to determine the cause and treatment.

An An, 40~49 year old female. Ask Date: 2014/07/21

Dr. Gao Chunde reply Neurology

If there is damage to the facial nerve, which primarily consists of motor fibers that control facial muscle movements, it will inevitably lead to related functional impairments.
One can self-assess whether facial expressions appear unnatural (indicating weakness in certain facial muscles), and whether there is any asymmetry or atrophy of the muscles.
If such signs are present, it is more significant for further examination.
If not, it is usually just irritation of surrounding tissues or heightened excitability of the nerve itself, without reaching the level of damage, and examination results may be normal.
Evaluations may include facial nerve conduction studies, blink reflex tests, needle electromyography, and if necessary, brain MRI may also be required.

Reply Date: 2014/07/21

More Info

Facial myokymia is a condition characterized by involuntary muscle contractions in the face, often described as a wave-like movement of the facial muscles. This phenomenon can be distressing and may arise from various underlying causes, including nerve damage, irritation, or other neurological conditions. Understanding the causes, symptoms, and treatment options for facial myokymia is essential for effective management and alleviation of symptoms.

Causes of Facial Myokymia
1. Nerve Injury: As mentioned in your case, facial myokymia can occur following trauma or surgical procedures that affect the facial nerve. In your situation, the combination of cosmetic surgery and subsequent trauma to the face could have led to nerve irritation or damage. This can result in abnormal electrical discharges from the nerve, leading to involuntary muscle contractions.

2. Scar Tissue Formation: Post-surgical healing can lead to the formation of scar tissue, which may compress or irritate nearby nerves. This can result in symptoms similar to those of facial myokymia. The scar tissue may also cause abnormal connections between nerves and muscles, leading to involuntary movements.

3. Neurological Disorders: In some cases, facial myokymia may be associated with neurological conditions such as multiple sclerosis or other demyelinating diseases. These conditions can affect the central nervous system and lead to abnormal nerve signaling.

4. Overactive Nerve Responses: Sometimes, the facial nerve may become overly sensitive due to various factors, including stress, fatigue, or other environmental influences. This heightened sensitivity can lead to involuntary muscle contractions.

Symptoms of Facial Myokymia
The primary symptom of facial myokymia is the involuntary twitching or rippling of the facial muscles. This may not be visible to others but can be felt by the individual. Other symptoms may include:
- A sensation of movement or twitching beneath the skin.

- Muscle fatigue or discomfort in the affected area.

- Anxiety or distress due to the involuntary movements.

Treatment Options
1. Physical Therapy: Engaging in facial exercises and massage may help reduce muscle tension and improve nerve function. Your doctor has suggested facial massage, which can be beneficial in desensitizing the affected area and promoting relaxation.

2. Medications: In some cases, medications such as muscle relaxants or anticonvulsants may be prescribed to help manage symptoms. These medications can help stabilize nerve activity and reduce involuntary contractions.

3. Nerve Blocks or Injections: In certain situations, targeted nerve blocks or injections of botulinum toxin (Botox) may be considered to alleviate symptoms. Botox can temporarily paralyze the overactive muscles, providing relief from involuntary movements.

4. Surgical Intervention: If the myokymia is due to significant nerve compression or scar tissue formation, surgical intervention may be necessary. This could involve the release of compressed nerves or the removal of scar tissue. However, this option should be carefully evaluated by a qualified neurosurgeon or neurologist.

5. Neurological Evaluation: Given your history of surgery and trauma, it is crucial to undergo a thorough neurological evaluation. This may include imaging studies such as MRI or CT scans, as well as nerve conduction studies to assess the function of the facial nerve and rule out other potential causes.

Conclusion
Facial myokymia can be a complex condition with various underlying causes. It is essential to work closely with a neurologist or a specialist in facial nerve disorders to determine the most appropriate treatment plan tailored to your specific situation. Early intervention and a comprehensive approach can significantly improve your quality of life and alleviate the distress associated with this condition. If you are in the United States, consider seeking a referral to a specialized clinic that focuses on facial nerve disorders for a more targeted evaluation and treatment plan.

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