Uncontrolled Facial Muscle Movements: Causes and Treatments

Continued inquiry: Involuntary twitching of the left cheek?

Dear Dr.
Gao,
Thank you very much for your response.
My cheeks appear completely normal, they move naturally, and there is no asymmetry or atrophy.
If the issue is due to some irritation of the tissues surrounding the nerve or increased excitability of the nerve itself, what treatment options are available? How can it be resolved? Why has it not disappeared even two years after the cosmetic surgery? Is surgical intervention necessary? Thank you very much!
Best regards,
An An
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Previous Inquiry and Response:
Dear Dr.
Gao, thank you for your reply.
If the symptoms are due to facial nerve injury caused by the cosmetic surgery and subsequent trauma, is it possible that my symptoms are due to abnormal adhesion of the facial nerve to surrounding tissues? Or could it be due to scar tissue or vascular compression? (If the nerve were severed, I should feel numbness, correct? But I do not feel numb.) What treatment options are available, and is there a definitive solution? Can a facial nerve detector be used to 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 response.
Thank you very much!
An An
[Response Date] 2014/07/22
[Response] Dr.
Gao: Taichung Hospital / Neurology / Dr.
Gao Chunde
If there is damage to the facial nerve, which primarily controls the movement of facial muscles, such damage will inevitably lead to related functional impairments.
You can assess whether your facial expressions appear unnatural (indicating weakness in certain facial muscles) and whether there is any asymmetry or atrophy of the muscles.
If there are such signs, further examination is warranted.
If not, it is likely just irritation of the surrounding tissues or heightened excitability of the nerve itself, without significant damage, and examinations may yield normal results.
Potential examinations include facial nerve conduction studies, blink reflex tests, needle electromyography, and possibly brain MRI if necessary.

An An, 40~49 year old female. Ask Date: 2014/07/22

Dr. Gao Chunde reply Neurology

You may first consider local massage to relax the nerves and muscles, or supplement with some B vitamins.
Some physicians may prescribe medications to calm the nerves and relax the muscles.
If the symptoms persist or if there are new changes, it is advisable to consult a neurologist for further evaluation to rule out any underlying issues.
Surgery is generally performed only when a specific lesion has been identified for removal or dissection.

Reply Date: 2014/07/22

More Info

Understanding uncontrolled facial muscle movements, particularly in the context of your situation, involves a multifaceted approach that considers both the physiological and psychological aspects of facial nerve function. Based on your description, it seems that you are experiencing a condition that may be related to facial myokymia, which is characterized by involuntary muscle contractions or twitching. This condition can arise from various factors, including nerve irritation, previous trauma, or even surgical interventions.

Causes of Uncontrolled Facial Muscle Movements
1. Nerve Sensitivity: After surgical procedures, especially those involving the face, nerves can become overly sensitive. This heightened sensitivity may lead to abnormal electrical discharges in the facial muscles, resulting in the twitching or "worm-like" movements you described.
2. Scar Tissue Formation: Surgical interventions can lead to the formation of scar tissue, which may entrap or irritate nearby nerves. This can cause abnormal sensations or movements in the affected area.
3. Trauma: The incident where your daughter accidentally hit your face could have exacerbated any underlying nerve issues or contributed to the development of scar tissue, leading to the symptoms you are experiencing.

4. Psychological Factors: Anxiety and stress can also manifest physically, potentially exacerbating muscle tension and involuntary movements. The psychological aspect of dealing with a visible and persistent issue can create a cycle of anxiety that may worsen the symptoms.

Treatment Options
1. Physical Therapy: Engaging in physical therapy, particularly with a focus on facial exercises, can help improve muscle control and reduce involuntary movements. A trained therapist can guide you through specific exercises designed to strengthen the facial muscles and improve coordination.

2. Massage Therapy: As your doctor suggested, regular massage may help desensitize the area and reduce muscle tension. Gentle, consistent massage can promote blood flow and may help alleviate some of the discomfort associated with nerve sensitivity.

3. Medications: In some cases, medications such as muscle relaxants or anticonvulsants may be prescribed to help manage involuntary muscle movements. Consulting with a neurologist can provide insights into whether this approach is suitable for your condition.

4. Botulinum Toxin Injections: For more persistent cases, botulinum toxin (Botox) injections can be effective in temporarily paralyzing the overactive muscles, thereby reducing involuntary movements. This treatment is often used for conditions like facial spasms and may provide relief.

5. Surgical Intervention: If conservative treatments do not yield satisfactory results and if there is evidence of nerve entrapment or significant scar tissue affecting nerve function, surgical options may be considered. This could involve decompression of the affected nerve or removal of scar tissue. However, this decision should be made in consultation with a specialist who can assess the risks and benefits based on your specific situation.

Why Symptoms Persist
The persistence of your symptoms two years post-surgery could be attributed to several factors, including the degree of nerve irritation, the presence of scar tissue, and the overall healing process. Nerves can take a significant amount of time to heal, and in some cases, they may not return to their pre-injury state.

Next Steps
Given your situation, it would be prudent to consult with a neurologist or a facial nerve specialist who can conduct a thorough evaluation. This may include nerve conduction studies or imaging to assess the condition of the facial nerve and surrounding tissues. Understanding the underlying cause of your symptoms is crucial for determining the most effective treatment plan.

In summary, while your facial movements may not appear abnormal to others, the sensations you experience are valid and warrant attention. A multidisciplinary approach involving physical therapy, possible medication, and careful monitoring by specialists can help you manage and potentially alleviate your symptoms.

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