INFORMATION FOR HEALTH CARE PROFESSIONALS
HEAD AND NECK LYMPHEDEMA
What is Lymphedema?
Lymphedema is a swelling of a body part, most often an arm or a leg, caused by the abnormal accumulation of lymph fluid. It can also occur in the face, neck, abdomen, groin and lung.
This condition most often causes a feeling of heaviness, swelling of a limb or body part, discomfort and pain, repeated episodes of infection and thickening of the skin. As the condition progresses, affected areas can become hardened, there can be leakage of lymph and normal functions can become restricted.
Secondary lymphedema is caused by an injury, scarring or removal of the lymph nodes. In this country, this usually occurs as a result of previous radiation and/or surgery of the lymph nodes in the neck, armpit, pelvis or groin. Such treatments are commonly given for cancers of the head and neck, breast, uterus, bladder, ovary, prostate or testicle and for malignant melanomas and lymphomas. Occasionally, secondary lymphedema is caused by trauma to or chronic infections of the lymph system.
Risk Factors for Secondary Head & Neck Lymphedema
• Neck, facial or oral surgery and radiation for the treatment of cancer
• Lymph node dissection, any level or multi-level in the neck and face
• Neck surgery other than cancer, traumas, burns, arthritis
• Plastic surgery, reconstruction or repair
• Tumours (benign or malignant) that obstruct the lymph vessel system
What is the treatment of Lymphedema?
Lymphedema is a serious condition which indicates that the lymph system is unable to handle the lymph load. As it is a progressive condition, treatment should ideally begin as soon as the problem is diagnosed or even better as a preventative program after radiation or removal of lymph nodes to prevent swelling from occurring.
The most effective form of treatment used by therapists in North America and Europe is Combined Decongestive Therapy (CDT). This includes:,br> 1. Manual Lymph Drainage – This is a specialized type of hands-on massage which stimulates and improves the functioning of the lymph vessel system. In addition to this, lymph can be re-routed into existing, alternate pathways to improve lymphatic return to the blood stream.
2. Compression Therapy – This includes compression garments and/or specialized bandaging.
3. Education – This includes basic information about the lymph vessel system, causes of lymphedema, self-massage and techniques for self-care, and instruction in the use of compression bandages and garments.
4. Exercise – exercise recommendations and guidelines.
5. Skin care – techniques and suggested products to keep skin healthy, to improve its condition or to deal with problems.
Combined Decongestive Therapy has proven to be effective for Head & Neck Lymphedema. CDT is a specialized post-graduate training for health care professionals (135 hours).
Indications for CDT Referral for Head & Neck Lymphedema
• Failure to heal wound sites
• Swelling in neck, submental, facial, intra-oral areas
• Pain on movement or due to increased pressure from swelling
• Decreased function in tongue movement, swallowing, speech, or decreased function of muscles due to swelling
• Impaired ADL due to limited neck and shoulder ROM & strength
Goals for CDT Treatment
• Early treatment can minimize the progression of symptoms and functional limitations
• Decongest the edematous areas with manual lymph drainage
• Prevent the refilling of tissues
• Minimize scar formation and breakdown fibrosis
• Assist client to develop personal care plan
• Empower client and family with long term management strategies
• Co-create strategies to enhance QOL