Background: Hemifacial spasm (HFS) is a chronic hyperkinetic facial nerve disorder characterized by involuntary, unilateral facial muscle contractions. While well-described in adults, where neurovascular compression of the facial nerve root exit zone predominates, pediatric HFS remains profoundly underrecognized. Fewer than 50 cases have been reported worldwide, and no standardized diagnostic criteria, imaging protocols, or treatment guidelines exist for this population. Clinicians are forced to extrapolate from adult data despite fundamental differences in anatomy, etiology, neurodevelopment, and psychosocial impact.
Objective: This narrative review and call to action synthesizes the existing literature on pediatric HFS, identifies structural gaps impeding standardized care, and proposes a foundational framework for diagnostic classification, etiological investigation, and age-stratified treatment. Methods: A comprehensive search of PubMed, EMBASE, Cochrane, CINAHL, and Google Scholar was performed using terms including hemifacial spasm, facial nerve hyperkinesia, pediatric, children, and adolescent. All case reports, case series, and review articles describing HFS in patients under 18 years of age were included. Evidence was synthesized across 6 domains: clinical phenotyping, etiological and neuroimaging characterization, treatment modalities, procedural standardization, longitudinal follow-up, and patient-centered outcome measurement.
Results: The literature encompassed fewer than 50 pediatric cases, reflecting profound underreporting and the absence of a unifying diagnostic framework. Etiological heterogeneity was a defining feature. Posterior fossa lesions, vascular anomalies, demyelinating disease, and idiopathic presentations were all represented but inconsistently evaluated. Treatment approaches, where reported, included botulinum toxin injection and microvascular decompression, with selection appearing to reflect institutional preference rather than evidence-based criteria. Age-stratified protocols were absent, longitudinal data were sparse, and quality-of-life measures were virtually nonexistent.
Objective: This narrative review and call to action synthesizes the existing literature on pediatric HFS, identifies structural gaps impeding standardized care, and proposes a foundational framework for diagnostic classification, etiological investigation, and age-stratified treatment. Methods: A comprehensive search of PubMed, EMBASE, Cochrane, CINAHL, and Google Scholar was performed using terms including hemifacial spasm, facial nerve hyperkinesia, pediatric, children, and adolescent. All case reports, case series, and review articles describing HFS in patients under 18 years of age were included. Evidence was synthesized across 6 domains: clinical phenotyping, etiological and neuroimaging characterization, treatment modalities, procedural standardization, longitudinal follow-up, and patient-centered outcome measurement.
Results: The literature encompassed fewer than 50 pediatric cases, reflecting profound underreporting and the absence of a unifying diagnostic framework. Etiological heterogeneity was a defining feature. Posterior fossa lesions, vascular anomalies, demyelinating disease, and idiopathic presentations were all represented but inconsistently evaluated. Treatment approaches, where reported, included botulinum toxin injection and microvascular decompression, with selection appearing to reflect institutional preference rather than evidence-based criteria. Age-stratified protocols were absent, longitudinal data were sparse, and quality-of-life measures were virtually nonexistent.