Ep. 188 Surgical Management of Synkinesis and Static Procedures for Flaccid Facial Palsy with Dr. Shiayin Yang

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Facial nerve injury affects each patient in a unique way. Accordingly, surgical treatment of facial paralysis must be meticulously planned and personalized. In this episode, Dr. Shiayin Yang, Associate Professor of Otolaryngology at Vanderbilt University, addresses management of synkinesis and static procedures for flaccid facial palsy with host Dr. Ashley Agan.

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SYNPOSIS

First, Dr. Yang reviews the difference between flaccid and non-flaccid (including synkinetic) facial paralysis. She describes her approach to facial paralysis, which includes clarifying the patient’s diagnosis and thoroughly examining the facial nerve function. Dr. Yang then transitions the conversation to surgical solutions, emphasizing dual goals of restoring symmetry and function. She divides her discussion to first tackle synkinesis and then static procedures for flaccid paralysis. Procedures discussed include Botox, brow lift, blepharoplasty, myectomy, and neurectomy as well as lower eyelid and midface procedures and temporalis tendon transfer. While surgical approaches to the two conditions differ, eye protection represents an important theme throughout. The episode concludes with Dr. Yang’s pearls for approaching these complex surgical problems and a reminder of how facial paralysis affects patients’ emotional health.

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TIMESTAMPS

00:00 - Introduction

02:36 - Understanding Flaccid & Non-Flaccid Facial Paralysis

07:13 - Botox for Facial Synkinesis

12:38 - History-Taking & Physical Exam in Facial Paralysis

15:07 - Surgical Management of Synkinesis

30:47 - Patient Counseling and Motivation

32:47 - Static Procedures for Flaccid Facial Palsy

37:26 - Nuances of Peri-Ocular Procedures

43:42 - Lower Eyelid & Midface Considerations

53:00 - Dynamic Surgery Options

56:56 - Final Surgical Pearls

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RESOURCES

Dr. Shiayin Yang’s Vanderbilt University Profile: https://www.vanderbilthealth.com/doctors/yang-shiayin

BackTable ENT Episode 151- Navigating Synkinesis: From Diagnosis to Comprehensive Care with Dr. Shiayin Yang

https://open.spotify.com/episode/1JucnHB8tNC5qRW6u82ie8?si=ba729d3f3e164d6f

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