Hemifacial spasm consists of irregular, but repetitive clonic twitching of the muscles of one side of the face. Usually it is first involved around the eyes, the repetitive twitching spreads slowly to involve the whole face. It most commonly affects middle aged or elderly women, and usually appears with an aberrant vascular cross-compression near the root entry zone (REZ) of VII nerve. Among numerous approaches to treat facial spasm, only Jannetta's microvascular decompression has confirmed efficacy. However facial nerve block by needle insertion technique seems to be of benefit in patients with mild spasm, the elderly, poor risks and those who refuse the craniotomy. To treat our three patients with hemifacial spasm, we did physical facial nerve block by a direct puncture of the facial nerve trunk just at its exit from the stylomastoid foramen. Satisfactory results were obtained by the treatment employed. This technique is a valuable method in the treatment of hemifacial spasm.