unilateral facial spasm

Moderators: kwyss, Sillevis

unilateral facial spasm

Postby Paula » Mon Sep 19, 2011 6:00 pm

60ish male referred for cerv pain, lumbar pain and unilateral facial spasm that pulls his mouth open. The patient reports no neck or lumbar pain only stiffness. Primary c/o of facial spasm to include waking him up at night and interfering with social interaction. He is a smoker and no prior hx of facial spasms. He did have botox without success. Since the misfiring is probably a result of the blood vessel touching the nerve...how can treating the cervical spine help decrease his symptoms other than some soft tissue work on the lateral pterygoid. There was no palpable asymmetry for the TMJ.
Paula
 
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Re: unilateral facial spasm

Postby Sillevis » Sat Sep 24, 2011 12:39 am

Ok so the referral seems not an appropriate reflection of the issues at hand. How is the cervical motion? Is his mandible moving in the normal 4:1:1 ratio (Opening: lateral side: anterior slide)? Not sure what you mean with misfiring results in bloodvessel touching the nerve? can you expand on this thought?
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Re: unilateral facial spasm

Postby Paula » Mon Sep 26, 2011 7:51 pm

It is my understanding that most hemifacial spasms are a result of a blood vessel being in an awkward postion and touching the facial nerve and overtime wears off the outer portion of the nerve causing misfiring. My understanding is that the botox treatment is most successful for this condition, but didn't work for this patient although he only had 1 treatment.I don't have much experience with TMJ issues as I did not assess mandibular distraction or lateral gliding but with palpation of the TMJ with open/close there was no palpable dysfunction noted. He does have an approx 50% limitation in CSA ROM all planes but reports no pain only stiffness. I'm not sure what direction to go with his treatment as his only complaint is that of the facial spasms.
Paula
 
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Re: unilateral facial spasm

Postby kwyss » Sun Oct 02, 2011 9:42 am

I have a patient that has chronic muscle imbalance of her fascial muscles mirroring a Belse Pulsy but not confirmed by EMG testing. She responds very well to upper cervical (o-C3) facet mobilization combined with
facial myofascial techniques. Her problem is repeated whiplash with instability of o-C2. I found this link that explains the corrolation without having to go in the neurology books. http://www.upcspine.com/anatomy3.htm
kwyss
 
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Re: unilateral facial spasm

Postby Paula » Mon Oct 03, 2011 7:25 pm

Thank you...I will check it out.
Paula
 
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