Facial Nerve Issues: Diagnosis and Treatment Options

Continued inquiry: Involuntary twitching of the left cheek?

Dear Dr.
Gao,
I consulted with a neurologist in the United States, who prescribed me Lyrica 50mg.
However, I feel it only addresses the symptoms and not the root cause.
Additionally, I found that the side effects are significant, and it doesn't resolve the underlying issue, so I don't think it's worth trying.

Could my condition be evaluated using electromyography (EMG) or other tools to identify the compressed nerve? Is it possible to use a facial nerve detector and perform surgery to release the compressed nerve? What are the risks involved? What is the success rate? How long is the recovery period? Thank you very much!
Best regards,
An An
---
Dear Dr.
Gao,
Thank you for your response.
My cheek appears completely normal, moves naturally, and shows no asymmetry or atrophy.
If the issue is due to irritation of surrounding tissues or heightened excitability of the nerve itself, how should it be treated? 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
---
Dear Dr.
Gao,
Thank you for your reply.
If the second scenario is true, where the facial nerve was injured due to cosmetic surgery and subsequent trauma, could my symptoms be due to abnormal adhesions between the facial nerve and surrounding tissues, or compression from scar tissue or blood vessels? (If the nerve were severed, I would likely 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!
Best regards,
An An
---
Response from Dr.
Gao:
If there is damage to the facial nerve, which primarily controls the movement of facial muscles, it will inevitably lead to functional impairments.
You can assess whether your facial expressions appear unnatural (indicating weakness in certain facial muscles) or if there is any asymmetry or atrophy.
If these signs are absent, it is likely that the issue is related to irritation of surrounding tissues or heightened excitability of the nerve itself, rather than actual damage, and tests may yield normal results.

Recommended examinations include facial nerve conduction studies, blink reflex tests, and needle electromyography.
In some cases, a brain MRI may also be necessary.

I suggest considering local massage to relax the nerves and muscles, or supplementing with B vitamins.
Some physicians may prescribe medications to calm the nerves and relax the muscles.
If symptoms persist or new changes occur, it is advisable to consult a neurologist for further evaluation to rule out any underlying issues.
Surgery is generally reserved for cases where a specific lesion has been identified for dissection or removal.

An An, 40~49 year old female. Ask Date: 2014/09/10

Dr. Gao Chunde reply Neurology

If there is no muscle weakness (such as facial asymmetry or muscle atrophy), the primary approach to treatment is conservative management.
There is no need for specific interventions like electromyography (EMG) or surgery (which would cause further damage), as it is merely a peripheral nerve issue, making further examination and treatment quite challenging.
Any decision regarding surgical intervention would be analyzed and compared by specialists in neurosurgery or plastic surgery, who have more extensive experience and expertise in this area.

Reply Date: 2014/09/10

More Info

Facial nerve issues, particularly facial nerve paralysis or dysfunction, can significantly impact a person's quality of life. The symptoms you described, such as facial asymmetry, discomfort in the ear, and headaches, may indicate a condition like Bell's palsy or other forms of facial nerve dysfunction. Understanding the diagnosis and treatment options is crucial for effective management.

Diagnosis
The diagnosis of facial nerve issues typically involves a thorough clinical evaluation by a neurologist or an otolaryngologist (ENT specialist). The physician will assess the patient's medical history, perform a physical examination, and may order additional tests such as:
1. Electromyography (EMG): This test measures the electrical activity of muscles and can help determine the extent of nerve damage.

2. Nerve Conduction Studies: These tests assess how well electrical signals travel through the facial nerve.

3. Magnetic Resonance Imaging (MRI): An MRI can help visualize any structural abnormalities, such as tumors or lesions, that may be compressing the nerve.

4. CT Scans: These may be used to evaluate the bony structures around the facial nerve.

Treatment Options
Treatment for facial nerve dysfunction varies depending on the underlying cause. Here are some common approaches:
1. Medications: Corticosteroids are often prescribed to reduce inflammation and swelling around the nerve. Antiviral medications may be used if a viral infection is suspected.

2. Physical Therapy: Facial exercises can help improve muscle strength and coordination. A physical therapist specializing in facial rehabilitation can provide tailored exercises.

3. Acupuncture: Some patients find relief from symptoms through acupuncture, which may help stimulate nerve function and reduce pain.

4. Surgery: In cases where there is a clear structural cause for the nerve compression (e.g., a tumor or severe scarring), surgical intervention may be necessary. This could involve decompression of the nerve or repair of any damaged structures.

5. Pain Management: Medications such as gabapentin or pregabalin (Lyrica) may be prescribed for neuropathic pain. However, as you mentioned, these medications primarily address symptoms rather than the underlying cause.

6. Vitamin Supplementation: Some studies suggest that B vitamins, particularly B6 and B12, may support nerve health. However, clinical evidence is limited, and it is advisable to discuss supplementation with a healthcare provider.

Risks and Considerations
Surgical options carry inherent risks, including infection, bleeding, and potential worsening of symptoms. The success rate of surgery depends on the specific condition being treated and the overall health of the patient. Recovery time can vary widely; some patients may see improvement within weeks, while others may take months to fully recover.

Conclusion
If you are experiencing persistent symptoms despite conservative treatment, it is essential to consult with a specialist who can provide a comprehensive evaluation and discuss the potential benefits and risks of further diagnostic testing or surgical options. It is also important to manage expectations regarding recovery, as complete restoration of function may not always be possible. Engaging in supportive therapies, such as physical therapy and possibly acupuncture, may enhance recovery and improve quality of life. Always ensure that any treatment plan is tailored to your specific needs and circumstances, and maintain open communication with your healthcare providers.

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