Head and Neck Lymphedema
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- What happens when lymphedema of the head or neck is benign?
- Stagnated fluid rich protein will cause poor oxygenation of the tissues, reduced macrophage activity, increased risk of infection, low grade inflammation, and increased interstitial CT. It will progress to more severe symptoms if the lymphedema is not treated.
- How long should the surgical area be avoided when performing MLD on a patient with head/neck lymphedema?
- For at least one week.
- Can MLD cause a recurrence of lymphedema?
- No!
- What is the focus of exercise for this patient population?
- The muscles of mastication and cervical muscles. Often modified to include C-ROM, postural exercises, shoulder programs, and TMJ mobility. Traditionally done with the compressive bandages or mask in place.
- What benefits does compression therapy provide to patient with head/neck lymphedema?
- Reduces production of lymph, decreases ultrafiltration to reduce refill of tissue, and aids in scar management.
- What are the three methods of compression therapy for head/neck lymphedema?
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Compression Chin Strap
Compression Mask
Compressive Bandages - What are some barriers to compression wear?
- Compression of trachea at night which contributes to sleep apnea, claustrophobia, patient compliance, and skin irritation/breakdown.
- What are some alternative compression techniques?
- Tubigrip over the head (use layers to add compression), specialized bandages, ski/scuba masks, and custom made masks.
- What are some precautions to keep in mind when treating head/neck lymphedema patients?
- No MLD over irradiated skin, no thermal modalities, graft precautions, hypersensitivity of area, breathing/apnea, and the effects of chemotherapy.
- What is the scar presentation from a unilateral neck dissection?
- From mastoid process to midline. Drainage pattern will have to be to the uninvolved side where the lymph node bed is still intact.
- What occurs during a bilateral neck dissection?
- The scar presentation is from mastoid process to mastoid process. The XRT field is bilateral. Most of the major lymph node groups in the neck are gone and fluid must be redirected to deeper nodes and alternative node beds. Anterior drainage patterns are normally the most effective.
- What are some barriers to treatment in this patient population?
- The timing of the initiation of therapy (pre/post XRT, pre scar healing, etc.), patient willingness to attend therapy four to five days per week, and the willingness of the patient and the patient's family to learn the necessary skills to manage the lymphedema.