Hereditary hypertrophic neuropathy is a syndrome of various causes and different modes of clinical presentation. Reports on cases with facial and trigeminal involvement are rare. The present case did have such involvement and approximated a syndrome described by Hellsing of facial hemispasm, trigeminal pain, and peripheral neuropathy. Nonspecific histologic changes occur in hypertrophic neuropathy. Limited forms of hereditary neuropathy confined to single cranial nerves may occur and familial cases of hemifacial spasm may represent such a condition.