Nose Twitching After Rhinoplasty

Nasal Myoclonus (Involuntary Contraction of Nose Muscles) After Nose Aesthetic

The patient, who had undergone rhinoplasty in another clinic, applied to our clinic for revision rhinoplasty and during the application he mentioned a complaint unrelated to the shape, "nose twitching","uncontrollable nasal muscles spasm" or "nasal myoclonus". This is a situation that I have seen several times in my professional life, which is not easy to explain.

Cause of Nose Twitching After Rhinoplasty

Nasal myoclonus,Nose twitching,
The reason for the appearance of twitching or myoclonus in certain areas of the nose after the rhinoplasty operation may be the regrowth of the nerve endings cut under the skin towards the nasal muscles and causing innervation in these muscles or irritation of the nerves that normally innervate these muscles due to swelling or blunt trauma.
It can be thought that there is no serious underlying disease and may be associated with the operation in patients who did not have previous myoclonus or twitching of the nose and who developed this condition after rhinoplasty operation. If there is only twitching on the nose and it appeared after the operation, it is not always necessary to carry out further examination and treatment for the causes of myoclonus listed below.

Treatment of Nose Twitching After Rhinoplasty

It can be stated that in patients whose nose twitches after rhinoplasty, there may be a decrease in muscle twitches over time, and waiting may be the best choice. However, in patients who are very disturbed by nasal twitching, application of botox to the nose is another treatment option.

I would like to add general information about Myoclonus below.

Myoclonus Symptoms

Myoclonus can sometimes be severe and may be expressed by patients to the physician as a complaint. Our patient with nasal myoclonus applied because of involuntary movement on the nose and stated that this condition occurred after the patient's previous rhinoplasty operation.

In Creutzfeldt-Jacob Disease, myoclonus may occur when people are suddenly startled (startle myoclonus), which can be an early sign of the disease.

Myoclonus Definition

Myoclonus is involuntary, very rapid contraction or twitching of a muscle or muscle group.

Causes of Myoclonus

Myoclonus can also occur normally and does not necessarily occur due to any disease. Perhaps the most obvious thing you can think of is the involuntary muscle contraction that occurs while falling asleep. So normally, myoclonus can occur, usually while a person is falling asleep. In this case, sometimes due to myoclonus while starting to sleep, patients may wake up suddenly (from the outside, it can be seen as frightened and suddenly awakened).

However, in some cases, myoclonus may be caused by a disorder such as (Information here excerpted from - source : Myoclonus - Brain, Spinal Cord, and Nerve Disorders - MSD):
  • Liver failure
  • Kidney failure
  • Brain damage due to a virus (such as encephalitis due to herpes simplex)
  • Brain damage after cardiac arrest (when the heart's pumping stops suddenly)
  • Metabolic disorders (such as a high blood sugar level or low blood sugar level or low levels of calcium, magnesium, or sodium)
  • Oxygen deprivation
  • Head injuries
  • Dementia with Lewy bodies
  • Huntington disease
  • Parkinson disease
  • Alzheimer disease (occasionally)
  • Creutzfeldt-Jakob disease
  • Certain seizure disorders (such as juvenile myoclonic epilepsy)
Myoclonus can occur after a person takes high doses of certain drugs such as the following:
  • Antihistamines
  • Some antidepressants (such as amitriptyline)
  • Some antibiotics (such as penicillin and cephalosporins)
  • Bismuth
  • Levodopa (used for Parkinson disease)
  • Opioid pain relievers

Myoclonus Diagnosis

After the doctor's examination, blood tests, usually kidney and liver function tests, and blood sugar, calcium, magnesium or sodium levels can be checked to understand that there is no underlying metabolic disease.

Magnetic resonance imaging can be performed to understand the problems that may arise in the brain due to Alzheimer's disease or Creutzfeldt-Jacob disease. 

Myoclonus Treatment

If an underlying cause is detected in the treatment of myoclonus, it is necessary to plan the treatment for this cause. In addition, drugs can be used to reduce symptoms or the use of drugs that can cause myoclonus should be stopped.

If the underlying cause cannot be treated, certain anti-seizure medications or sedative drugs can reduce symptoms can be used.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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