Pediatric Hemifacial Spasm: A Narrative Review and Call to Action

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.