Ep. 188 Surgical Management of Synkinesis and Static Procedures for Flaccid Facial Palsy with Dr. Shiayin Yang
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. --- CHECK OUT OUR SPONSOR PearsonRavitz https://pearsonravitz.com/backtable --- 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. --- 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 --- 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