Successful treatment of hemifacial spasm with selective facial nerve block using doxorubicin (adriamycin) under local anesthesia.
OBJECTIVE
To describe our experience with selective chemical rhizotomy of facial nerves using adriamycin (ADM) in a patient with hemifacial spasm (HFS). This unique technique is less invasive than intracranial neurosurgery and enables one to perform a permanent nerve block under local anesthesia.


METHODS
The patient, a 73-year-old female, had difficulty opening her left eye. Following unsuccessful treatment with anti-epileptic medicine, she received selective intraneural injections of ADM under local anesthesia. One week after the surgery the spasms had disappeared completely. No major complications were caused by this procedure and there had been no recurrence of spasms 3 years after the surgery.


RESULTS
It is thought that recurrence of HFS should be observed after simple neurotomy due to regrowth of nerve fibers. However, this did not occur after chemical rhizotomy with ADM. This method clearly differs from previously used varieties of simple neurotomy because the latter technique does not cause severe destructive changes in the facial motor nucleus.


CONCLUSIONS
Selective facial nerve chemical rhizotomy with ADM under local anesthesia may be effective in treating a subgroup of patients with HFS, especially elderly patients and those in the high-risk group for general anesthesia and intracranial neurosurgery.
Ito
Makoto
M
Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan. makoto@orl.m.kanazawa-u.ac.jp
Hasegawa
Mitsuhiro
M
Hoshida
Sigeru
S
Miwa
Takaki
T
Furukawa
Mitsuru
M
D000368:Aged; D000772:Anesthesia, Local; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002610:Cheek / Q000294:innervation; D004317:Doxorubicin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005152:Facial Muscles / Q000294:innervation / Q000502:physiology; D005154:Facial Nerve / Q000187:drug effects*; D005260:Female; D019569:Hemifacial Spasm / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007267:Injections / Q000379:methods; D009407:Nerve Block; D016896:Treatment Outcome; D015050:Zygoma / Q000294:innervation
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin