Preliminary Experience With Head and Neck Lymphedema and Swallowing Function in Patients Treated for Head and Neck Cancer

Abstract

Lymphedema is a collection of high protein fluid in the interstitial tissues that results from trauma, infection, or oncologic treatment that impairs lymphatic drainage. The damaging effects of radiation therapy and surgery on the lymphatic system primarily include edema and fibrosis. Lymphedema most often is recognized as a potentially serious complication for patients with breast, gynecological, or genitourinary cancers that manifests as swelling of the extremities. However, lymphedema in the head and neck region is a common complication of treatments for head and neck cancer. When lymphedema involves the head and neck region, the cosmetic and functional sequelae may be significant. Potential side effects include problems with drooling, mastication, deglutition, articulation, airway obstruction, and poor self image. The potential effects of head and neck lymphedema on swallowing function have not been well-documented and are only recently recognized. Oral preparation and pharyngeal transit are likely most affected. Complete Decongestive Therapy (CDT) is the international standard of care for treating lymphedema of the extremities that combines manual lymphatic drainage (MLD), bandage compression, skin care, and targeted exercise. Preliminary evidence supports the effectiveness of CDT in patients with head and neck lymphedema after cancer treatment.

Patient perceptions of living with head and neck lymphoedema and the impacts to swallowing, voice and speech function

“…Participants who reported speech changes felt that swelling of their tongue impacted on their ability to speak clearly and be understood by others. These findings offer support for the notion that HNL in the oral cavity may further impair the functioning of the structures used in articulation (Lewin et al., ). The findings are also consistent with a small number of studies that have noted patient‐reported speech imprecision and unintelligibility in patients who experience HNL (Deng, Ridner, Murphy et al., ; Deng et al., ; Piso et al., ).…”

“…This lymphoedema may be external (i.e., on the face or neck), internal (i.e., within the oral cavity, pharynx or larynx), or a combination of both (Deng, Ridner, Dietrich et al., ). HNL that does not spontaneously resolve and is left untreated, may ultimately progress and result in the development of fatty tissue deposits and contribute to the development of fibrosis (Deng, Ridner, Dietrich, Wells, & Murphy, ; Lewin, Hutcheson, Barringer, & Smith, ; Ridner et al., ).…”

Lymphedema after combination treatment of head and neck tumors

“…По данным литературы, у пациентов с опухолями головы и шеи при нарушении глотания в 30 % случаев обнаружива-ется внутренняя лимфедема [10], которая может на-рушать также функции жевания, дыхания, речи.…”

Arm Lymphedema as a Consequence of Breast Cancer Therapy

“…However, it has been studied in cases of melanoma, gynecological cancer, head and neck cancer as well as sarcoma (Lewin et al, 2010;Murphy et al, 2010;Smith et al, 2010;Cormier et al, 2010;Lacomba, 2010). Research shows that there is a lifelong risk of developing lymphedema due to cancer and the overall risk has been reported to be 15.5% [ Figure 2].…”

“…A physical examination assesses the vascular system, the soft tissue and skin surrounding the swollen body parts, palpation of lymph nodes, and looks for changes in the body systems in accordance with inherited lymphedemas (Wang, 2005;Moseley et al, 2008). Further diagnostic tests and imagining coupled with history, family history, and physical examination are used to correctly diagnose a patient (Lewin et al, 2010;Smith et al, 2010).…”