{"id":63031,"date":"2026-04-29T09:32:52","date_gmt":"2026-04-29T02:32:52","guid":{"rendered":"https:\/\/www2.si.mahidol.ac.th\/en\/?p=63031"},"modified":"2026-04-29T09:32:52","modified_gmt":"2026-04-29T02:32:52","slug":"hemifacial-spasm-when-less-is-more-adding-value-for-patients-and-the-healthcare-system","status":"publish","type":"post","link":"https:\/\/www2.si.mahidol.ac.th\/en\/highlights\/hemifacial-spasm-when-less-is-more-adding-value-for-patients-and-the-healthcare-system\/","title":{"rendered":"Hemifacial Spasm: When &#8216;Less&#8217; is &#8216;More&#8217;\u2014Adding Value for Patients and the Healthcare System"},"content":{"rendered":"<div id='av_section_1'  class='avia-section av-av_section-be5469b648f3c66bc848ea728be917cc main_color avia-section-small avia-no-border-styling  avia-builder-el-0  el_before_av_section  avia-builder-el-first  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><main  role=\"main\" 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Beauty and spa.'  height=\"512\" width=\"768\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/04\/cosmetologists-hands-making-medical-botox-injections-beautiful-blonde-skin-lifting-facial-treatment-beauty-spa-copy_0-768x512-1.jpg 768w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/04\/cosmetologists-hands-making-medical-botox-injections-beautiful-blonde-skin-lifting-facial-treatment-beauty-spa-copy_0-768x512-1-300x200.jpg 300w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/04\/cosmetologists-hands-making-medical-botox-injections-beautiful-blonde-skin-lifting-facial-treatment-beauty-spa-copy_0-768x512-1-705x470.jpg 705w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/><\/div><\/div><\/div><\/div><div  class='flex_column av-av_one_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_one_fifth  avia-builder-el-6  el_after_av_three_fifth  avia-builder-el-last  flex_column_div  '     ><\/div><\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='av_section_3'  class='avia-section av-av_section-f22f0f9dd672aac3df52cf5913f6ac08 main_color avia-section-default avia-no-border-styling  avia-builder-el-7  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-63031'><div class='entry-content-wrapper clearfix'>\n<div  class='flex_column av-av_one_fifth-2d22dc0500e159f2b39fe7a147caf14c av_one_fifth  avia-builder-el-8  el_before_av_three_fifth  avia-builder-el-first  first flex_column_div  '     ><\/div><div  class='flex_column av-av_three_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_three_fifth  avia-builder-el-9  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div  '     ><section  class='av_textblock_section av-mojfnjsz-dce94de49c163d67a253be414ebc8e09 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><h2>Hemifacial Spasm: When &#8216;Less&#8217; is &#8216;More&#8217;\u2014Adding Value for Patients and the Healthcare System<\/h2>\n<\/div><\/section><\/div><div  class='flex_column av-av_one_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_one_fifth  avia-builder-el-11  el_after_av_three_fifth  el_before_av_one_fifth  flex_column_div  '     ><\/div><div  class='flex_column av-av_one_fifth-2d22dc0500e159f2b39fe7a147caf14c av_one_fifth  avia-builder-el-12  el_after_av_one_fifth  el_before_av_three_fifth  first flex_column_div  column-top-margin'     ><\/div><div  class='flex_column av-av_three_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_three_fifth  avia-builder-el-13  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div  column-top-margin'     ><p><section  class='av_textblock_section av-mojfpwm9-f86158f742c5c99ed7bd00831ada3724 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-63032\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/04\/\u0e2d.\u0e19\u0e1e.\u0e2d\u0e31\u0e04\u0e23\u0e27\u0e34\u0e0a\u0e0d\u0e4c-\u0e40\u0e2d\u0e35\u0e48\u0e22\u0e21\u0e2a\u0e33\u0e2d\u0e32\u0e07\u0e04\u0e4c.jpg\" alt=\"\" width=\"200\" height=\"300\" data-wp-editing=\"1\" \/><\/p>\n<p><em>Lecturer Akarawit Eiamsamarng, MD<\/em><br \/>\n<em>Department of Ophthalmology<\/em><br \/>\n<em>Faculty of Medicine Siriraj Hospital, Mahidol University<\/em><\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mojftkqm-04826fbfd4a012543748a7901b5563a5\">\n#top .av_textblock_section.av-mojftkqm-04826fbfd4a012543748a7901b5563a5 .avia_textblock{\ncolumn-count:2;\n}\n<\/style>\n<section  class='av_textblock_section av-mojftkqm-04826fbfd4a012543748a7901b5563a5 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock av_multi_colums'  itemprop=\"text\" ><p><strong>A Randomized, Controlled, Non-inferiority, Crossover Trial on the Efficacy of Isolated Periocular Botulinum Toxin A Injections Versus Conventional Periocular and Adjunctive Lower Facial Injections in Hemifacial Spasm<\/strong><\/p>\n<p>Hemifacial spasm (HFS) is an uncommon neurological disorder with a profound impact on patients&#8217; lives. It is characterized by involuntary, unilateral spasms of facial muscles, typically originating around the eye (periocular area) and gradually progressing to the cheek, mouth, and chin. The condition is often chronic and tends to worsen over time. Many patients experience visual impairment due to eyelid spasms obstructing their vision, leading to a loss of confidence in social interactions and significantly affecting their emotional well-being and professional lives. Although not life-threatening, HFS is a condition that clearly &#8220;debilitates daily life,&#8221; making effective treatment critically important.<\/p>\n<p><strong>Botulinum Toxin: The Standard of Care Requiring Lifelong Injections<\/strong><\/p>\n<p>For decades, Botulinum Toxin A (BoNT-A) injections have been the mainstay of effective treatment for HFS, providing clear, temporary relief from muscle contractures. However, this modality has its limitations:<br \/>\n* It requires repeated injections every 3\u20134 months.<br \/>\n* It constitutes a significant burden for both the patient and the healthcare system.<br \/>\n* Injections into the lower facial muscles can lead to adverse effects, such as drooping of the mouth corner (oral commissure), facial asymmetry, and difficulty speaking.<\/p>\n<p>In standard clinical practice, many physicians have long administered injections to both the periocular and lower facial areas according to a &#8220;conventional protocol.&#8221; However, a key clinical observation was made during the COVID-19 pandemic: the mandatory use of face masks led to the omission of lower facial injections, yet patients&#8217; symptoms remained well-controlled. This prompted a crucial question: &#8220;Is it necessary to inject botulinum toxin into the lower face of every HFS patient?&#8221;<\/p>\n<p><strong>Research That Challenges the Conventional Standard<\/strong><\/p>\n<p>The study, &#8220;Efficacy of isolated periocular botulinum toxin A injections versus periocular and adjunctive lower facial injections in hemifacial spasm,&#8221; published in *Annals of Medicine* in 2025, was conducted by a team from the Department of Ophthalmology, Faculty of Medicine Siriraj Hospital. The research, led by Lecturer Akkarawich Eiamsam-ang, MD, Professor Niphon Chirapapaisan, MD, and Professor Wanicha Chuenkongkaew, MD, was designed as a Randomized, Controlled, Non-inferiority, Crossover trial.<\/p>\n<p>A total of 46 HFS patients received two treatment protocols at different times:<br \/>\n1. Isolated periocular injections (Botox administered only to the muscles around the eye).<br \/>\n2. Conventional injections (Botox administered to both the periocular and lower facial areas).<\/p>\n<p>The primary objective was to demonstrate that the isolated periocular injection method was &#8220;non-inferior&#8221; to the conventional method in controlling HFS symptoms.<\/p>\n<p><strong>Results That Shift the Clinical Paradigm<\/strong><\/p>\n<p><strong>The study revealed the following:<\/strong><br \/>\n* The isolated periocular injection method was non-inferior to the conventional method in controlling HFS symptoms, including those in the lower face.<br \/>\n* There were no statistically significant differences in patient-reported symptom scores (VAS), disease severity scales (HSGS, SMC), or quality of life measurements (HFS-30) between the two methods.<br \/>\n* The adverse effect of a drooping mouth corner was observed exclusively in the group receiving conventional injections.<br \/>\n* The isolated periocular method required a lower total dose of botulinum toxin, involved fewer injection sites (reducing pain), and resulted in higher patient satisfaction.<\/p>\n<p><strong>In other words:<\/strong><br \/>\n\u2013 Efficacy was comparable.<br \/>\n\u2013 The safety profile was superior.<br \/>\n\u2013 Patients reported a more &#8220;natural&#8221; facial appearance and function.<\/p>\n<p><strong>From Research Data to Real-World Patient Impact<\/strong><\/p>\n<p>Following the COVID-19 pandemic, the research team observed that over 85% of patients continued to choose the &#8220;isolated periocular injection&#8221; method, even when the option for conventional treatment was available. The primary reasons cited were the absence of facial distortion and the ability to speak, chew, and smile naturally, which enhanced their confidence in social settings. Furthermore, this refined approach was found to reduce the total annual cost to the healthcare system by over 19%\u2014a significant saving for clinics managing a large number of long-term HFS patients.<\/p>\n<p>Today, the isolated periocular injection protocol is implemented as the standard of care for all new HFS patients treated at the Ophthalmology clinic at Siriraj Hospital.<\/p>\n<p>This research was presented internationally and received the 1st Place Award for Outstanding Research at The 12th Asian Neuro-ophthalmology Society Meeting in the Hong Kong Special Administrative Region of the People&#8217;s Republic of China.<\/p>\n<p><strong>Implications for the Era of Precision Medicine<\/strong><\/p>\n<p>This research does more than simply change injection sites; it shifts the entire treatment paradigm from a &#8220;one-size-fits-all&#8221; approach to one that is &#8220;precisely tailored to the individual patient.&#8221; This embodies the core principle of Precision Medicine in clinical practice: treating the &#8220;person,&#8221; not just the disease.<\/p>\n<p><strong>Conclusion<\/strong><\/p>\n<p>Hemifacial Spasm is a chronic condition that, while not fatal, silently erodes a patient&#8217;s quality of life. This pivotal research from our Thai medical team demonstrates that sometimes, a &#8220;lesser&#8221; intervention can produce a more fitting and superior outcome for the patient. It marks a significant step for a medical practice that asks not only, &#8220;What is theoretically best?&#8221; but more importantly, **&#8221;What is best for this patient in their actual life?&#8221;<\/p>\n<p><strong>Research Team<\/strong><br \/>\n<em>Lecturer Akkarawich Eiamsam-ang, MD<\/em><br \/>\n<em>Professor Wanicha Chuenkongkaew, MD<\/em><br \/>\n<em>Dr. Manassawee Joradoln, MD<\/em><br \/>\n<em>Ms. Yanee Mukdar, BSc<\/em><br \/>\n<em>Professor Niphon Chirapapaisan, MD<\/em><br \/>\n<em>Lecturer Natthapon Rattanathamsakul, MD<\/em><br \/>\n<em>Mrs. Phakinee Rueangcharin, BSc<\/em><br \/>\n<em>Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University<\/em><\/p>\n<\/div><\/section><\/p><\/div><div  class='flex_column av-av_one_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_one_fifth  avia-builder-el-16  el_after_av_three_fifth  el_before_av_one_fifth  flex_column_div  column-top-margin'     ><\/div><div  class='flex_column 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el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div  column-top-margin'     ><div  id=\"avia-magazine-1\"  class='av-magazine av-av_magazine-878d4144cc3531eab4442f8ef04a8773  avia-builder-el-24  avia-builder-el-no-sibling   avia-builder-el-24  avia-builder-el-no-sibling ' ><div class='av-magazine-group sort_all'><article class='av-magazine-entry av-magazine-entry-id-64812 av-magazine-format-standard av-magazine-type-post av-magazine-entry-1 av-magazine-entry-small '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class=\"av-magazine-thumbnail\"><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-faculty-members-contribute-to-evtm-asia-2026-and-advance-international-collaboration-in-trauma-care\/' title='Link to: Siriraj Faculty Members Contribute to EVTM Asia 2026 and Advance International Collaboration in Trauma Care' class='av-magazine-thumbnail-link'><img decoding=\"async\" fetchpriority=\"high\" width=\"80\" height=\"80\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/CON-SUR-80x80.jpg\" class=\"wp-image-64817 avia-img-lazy-loading-not-64817 attachment-thumbnail size-thumbnail wp-post-image\" alt=\"\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/CON-SUR-80x80.jpg 80w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/CON-SUR-36x36.jpg 36w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/CON-SUR-180x180.jpg 180w\" sizes=\"(max-width: 80px) 100vw, 80px\" \/><\/a><\/div><div class=\"av-magazine-content-wrap\"><header class=\"entry-content-header\" aria-label=\"Post: Siriraj Faculty Members Contribute to EVTM Asia 2026 and Advance International Collaboration in Trauma Care\"><time class='av-magazine-time updated'  itemprop=\"datePublished\" datetime=\"2026-10-20T13:15:51+07:00\" >October 20, 2026<\/time><h3 class='av-magazine-title entry-title '  itemprop=\"headline\" ><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-faculty-members-contribute-to-evtm-asia-2026-and-advance-international-collaboration-in-trauma-care\/' title='Link to: Siriraj Faculty Members Contribute to EVTM Asia 2026 and Advance International Collaboration in Trauma Care'>Siriraj Faculty Members Contribute to EVTM Asia 2026 and Advance International Collaboration in Trauma Care<\/a><\/h3><\/header><\/div><footer class=\"entry-footer\"><\/footer><\/article><article class='av-magazine-entry av-magazine-entry-id-64795 av-magazine-format-standard av-magazine-type-post av-magazine-entry-2 av-magazine-entry-small '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class=\"av-magazine-thumbnail\"><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-international-visiting-scholar-at-department-of-surgery-2\/' title='Link to: Siriraj International Visiting Scholar at Department of Surgery' class='av-magazine-thumbnail-link'><img decoding=\"async\" fetchpriority=\"high\" width=\"80\" height=\"80\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/Prof.-Ross-Milner-3898-80x80.jpg\" class=\"wp-image-64799 avia-img-lazy-loading-not-64799 attachment-thumbnail size-thumbnail wp-post-image\" alt=\"\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/Prof.-Ross-Milner-3898-80x80.jpg 80w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/Prof.-Ross-Milner-3898-36x36.jpg 36w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/Prof.-Ross-Milner-3898-180x180.jpg 180w\" sizes=\"(max-width: 80px) 100vw, 80px\" \/><\/a><\/div><div class=\"av-magazine-content-wrap\"><header class=\"entry-content-header\" aria-label=\"Post: Siriraj International Visiting Scholar at Department of Surgery\"><time class='av-magazine-time updated'  itemprop=\"datePublished\" datetime=\"2026-10-20T10:59:19+07:00\" >October 20, 2026<\/time><h3 class='av-magazine-title entry-title '  itemprop=\"headline\" ><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-international-visiting-scholar-at-department-of-surgery-2\/' title='Link to: Siriraj International Visiting Scholar at Department of Surgery'>Siriraj International Visiting Scholar at Department of Surgery<\/a><\/h3><\/header><\/div><footer class=\"entry-footer\"><\/footer><\/article><article class='av-magazine-entry av-magazine-entry-id-64707 av-magazine-format-standard av-magazine-type-post av-magazine-entry-3 av-magazine-entry-small '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class=\"av-magazine-thumbnail\"><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-faculty-abroad-at-the-ecnp-2025-congress-in-germany\/' title='Link to: Siriraj Faculty Abroad at the ECNP 2025 Congress in Germany' class='av-magazine-thumbnail-link'><img decoding=\"async\" fetchpriority=\"high\" width=\"80\" height=\"80\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/970B496A-BBAD-4FA6-9818-02594DAC262C-Somboon-Hataiyusuk-80x80.png\" class=\"wp-image-64710 avia-img-lazy-loading-not-64710 attachment-thumbnail size-thumbnail wp-post-image\" alt=\"\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/970B496A-BBAD-4FA6-9818-02594DAC262C-Somboon-Hataiyusuk-80x80.png 80w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/970B496A-BBAD-4FA6-9818-02594DAC262C-Somboon-Hataiyusuk-36x36.png 36w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/970B496A-BBAD-4FA6-9818-02594DAC262C-Somboon-Hataiyusuk-180x180.png 180w\" sizes=\"(max-width: 80px) 100vw, 80px\" \/><\/a><\/div><div class=\"av-magazine-content-wrap\"><header class=\"entry-content-header\" aria-label=\"Post: Siriraj Faculty Abroad at the ECNP 2025 Congress in Germany\"><time class='av-magazine-time updated'  itemprop=\"datePublished\" datetime=\"2026-10-13T09:52:10+07:00\" >October 13, 2026<\/time><h3 class='av-magazine-title entry-title '  itemprop=\"headline\" ><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-faculty-abroad-at-the-ecnp-2025-congress-in-germany\/' title='Link to: Siriraj Faculty Abroad at the ECNP 2025 Congress in Germany'>Siriraj Faculty Abroad at the ECNP 2025 Congress in Germany<\/a><\/h3><\/header><\/div><footer class=\"entry-footer\"><\/footer><\/article><article class='av-magazine-entry av-magazine-entry-id-64756 av-magazine-format-standard av-magazine-type-post av-magazine-entry-4 av-magazine-entry-small '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class=\"av-magazine-thumbnail\"><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-faculty-abroad-at-the-1st-ashra-congress-in-japan-2\/' title='Link to: Siriraj Faculty Abroad at the 1st ASHRA Congress in Japan' class='av-magazine-thumbnail-link'><img decoding=\"async\" fetchpriority=\"high\" width=\"80\" height=\"80\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/logo_ashra-80x80.png\" class=\"wp-image-64757 avia-img-lazy-loading-not-64757 attachment-thumbnail size-thumbnail wp-post-image\" alt=\"\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/logo_ashra-80x80.png 80w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/logo_ashra-36x36.png 36w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/logo_ashra-180x180.png 180w\" sizes=\"(max-width: 80px) 100vw, 80px\" \/><\/a><\/div><div class=\"av-magazine-content-wrap\"><header class=\"entry-content-header\" aria-label=\"Post: Siriraj Faculty Abroad at the 1st ASHRA Congress in Japan\"><time class='av-magazine-time updated'  itemprop=\"datePublished\" datetime=\"2026-10-11T11:49:35+07:00\" >October 11, 2026<\/time><h3 class='av-magazine-title 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src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/main-80x80.png\" class=\"wp-image-64753 avia-img-lazy-loading-not-64753 attachment-thumbnail size-thumbnail wp-post-image\" alt=\"\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/main-80x80.png 80w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/main-36x36.png 36w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/10\/main-180x180.png 180w\" sizes=\"(max-width: 80px) 100vw, 80px\" \/><\/a><\/div><div class=\"av-magazine-content-wrap\"><header class=\"entry-content-header\" aria-label=\"Post: Siriraj Faculty Abroad at the 1st ASHRA Congress in Japan\"><time class='av-magazine-time updated'  itemprop=\"datePublished\" datetime=\"2026-10-11T11:09:40+07:00\" >October 11, 2026<\/time><h3 class='av-magazine-title entry-title '  itemprop=\"headline\" ><a 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