The lymph vessels drain fluid from tissues throughout the body and allow immune cells to travel throughout the body. Lymphedema is a localized lymphatic fluid retention and tissue swelling caused by a compromised lymphatic system.
Lymphedema, a common complication of radiation and surgery for head and neck cancer, is an abnormal accumulation of protein-rich fluid in the space between cells which causes chronic inflammation and reactive fibrosis of the affected tissues.
Radiation creates scarring which interferes with the function of the lymphatics. The cervical lymph nodes are generally removed when the cancer is excised. When the surgeons remove these glands they also take away the drainage system for the lymphatics and cut some of the sensory nerves. Unfortunately, most of the severed lymphatics and nerves are permanently cut. Consequently, it takes longer to drain the area, resulting in swelling. Like flooding after a heavy rain when the drainage system is broken, the surgery creates a backup of lymphatic fluid that cannot drain adequately, as well as numbness of the areas supplied by the severed nerves (usually in the neck, chin, and behind the ears). As a result, some of the lymphatic fluid cannot re-enter the systemic circulation and accumulates in the tissues.
There are two types of lymphedema that can develop in patients with head and neck cancer: an external visible swelling of the skin or soft tissue and an internal swelling of the mucosa of the pharynx and larynx. Lymphedema generally starts slowly and is progressive, rarely painful, causes discomfort in the form of a sensation of heaviness and achiness, and may lead to skin changes.
- Difficulty in breathing
- Impairment in vision
- Motor limitations (reduced neck motion, jaw tightness or trismus and chest tightness)
- Sensory limitations
- Speech, voice and swallowing problems (inability to use an electrolarynx difficulty in articulation, drooling, and loss of food from mouth)
- Emotional issues (depression, frustration and embarrassment)
Treatment of lymphedema includes:
- Manual lymph drainage ( face and neck, deep lymphatics, trunk, intra oral)
- Compressive bandages and garments
- Remedial exercises
- Skin care
- Elastic therapeutic tape (Kinesiotape)
- Oncology rehabilitation
A head and neck lymphedema therapist can teach the patient specific exercises to improve the range of head and neck motion.
The National Lympedema Network has a web site that can assist in locating a lymphedema specialists in North America, Europe and Australia.
A facial and neck self massage guide is also available.
The condition can also be treated with physical therapy and appropriate pain control. Medications such as gabapentin and carbamazepine may be prescribed. Acupuncture has been shown to decrease pain and shoulder dysfunction following neck dissection. Pain management services for treatment with narcotics and behavioral therapy are important assets in management of chronic pain.