FACIAL SPASM.
Painless spasm of the facial muscles arises from some reflex irritation of the facial nerve on one side, and when recent will disappear on the removal of the exciting cause, as in the form caused by dental caries or nose trouble. The severe type of lilepharospasm which involves the orbicularis palpebrarum usually disappears if the eye trouble causing the photophobia be treated promptly. All cases when chronic may, however, remain rebellious to treatment even when the exciting cause has been removed.
Sedatives, like Bromides, Indian Hemp, Morphia, Hyoscine, &c., may afford some temporary relief, hut their continuous administration is obviously fraught with danger owing to habit formation. Blistering over the mastoid may diminish or stop the spasm for a time, Electricity in every form is usually futile, but galvanism sometimes has afforded benefit in mild cases. Mayer recommends resection of the supraorbital nerve when this is sensitive, and when pressure over it inhibits the spasm.
Stretching of the facial nerve sometimes is curative, but as a rule the tonic spasm returns when the resulting facial paralysis passes off. Noceti
and others treat the condition by paralysing the nerve temporarily with an injection of r c.c. of a I per cent. Cocaine solution in So per cent. Alcohol introduced into the nerve trunk at the stylo-mastoid foramen. The injection may require repetition after two or three days' interval. The severe spasm accompanying trigeminal neuralgia (tic douloureux) can only be relieved by medical and surgical measures directed to the cure of the abnormal condition of the fifth nerve.
Habit-spasm or facial tic is a psychomotor phenomenon usually in volving several groups of muscles on both sides of the face, as in the grimaces of neurotic children. Its treatment will consist in moral and educational methods by which the self-control of the patient is strengthened, and the involved muscles kept in a healthy tone by massage and slowly regulated movements carried out in front of a mirror several times daily.