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Objective: to study the possibilities and effectiveness of treatment of patients with hemimasticatory spasm (HMS) with injections of botulinum neuroprotein type A (BNPA). The authors present a clinical case of long-term HMS: a 50-year-old patient, who suffered from the age of 20 from frequent involuntary muscle contractions that occurred in the temporal and masticatory muscles of the left half of the face. The patient was observed by neurologists for a long time, while the prescribed therapy did not have a satisfactory result. In the process of a comprehensive examination of the patient, in addition to intense involuntary contraction and pronounced hypertrophy of the affected muscles, secondary compensatory changes in other masticatory muscles were revealed, both on the side of the lesion and on the opposite side. BNPA treatment led to a robust improvement in the patient's condition.For patients with a long course of HMS and hypertrophy of the muscles involved in the pathological process, the use of bilateral injections of BNPA is the method of choice, since it not only effectively reduces the number of episodes, but also restores muscle balance, and also restores the motor function of the entire masticatory muscle group.