Head and Neck Lymphedema Treatment

INTRODUCTION

Lymphedema of the head and neck is a build-up of lymph above the shoulders and collar bones. It is most commonly caused by the secondary lymphedema (SLE); however, it can be present at birth due to primary lymphedema (PLE).

SIGNS AND SYMPTOMS

There is a wide range of causes of swelling in this area and these symptoms are often worse during the night, or at other time when the patient is lying down.

These problems often improve during the day when the patient is sitting up or walking around and the lymphatic fluid has had a chance to drain away from the head and neck.

The basic symptoms of this condition include visual signs of swelling such as puffiness anywhere around the head, face, or neck; however they may also include not-so-visible signs including:

• Trouble swallowing.
• The constant feeling of having a sore throat.
• Difficulty breathing.
• Pain when moving the neck and head into certain positions. Some of these causes are known as "referred pain."
  This term is used to describe pain that is perceived at a distance from the location of the injury's original site. 
  This pain could be caused by adhesions, radiation, or surgical scars located in other parts of the body that seem to be totally unrelated to the painful areas. 
• Scalp pain, tenderness, or tingling.
• Blurred vision, tearing and redness of the eye, aching pain behind the eye, or a twitching eye.
• Tinnitus (which is ringing in the ears), headaches, vertigo (dizziness), imbalance, or sinus congestion.
• The feeling of having a toothache when teeth becoming extrmely to pressure, heat, or cold. These symptoms may be  diagnosed by a dentist as being problems with the temporomandibular joint (TMJ) not functioning properly. 
• Trismus is the term that describes any restriction to mouth opening. This problem can be caused by surgery, radiation damage, or injury.
• Excessive salivation due to an inability to swallow often enough.
• A very dry mouth caused by failure of the salivary glands to produce sufficient saliva often causes dental decay. This is because normally the teeth are protected by being constantly bathed in saliva. A dentist should be consulted for assistance in preventing damage to the teeth.

DIAGNOSIS

Visual external signs are important. The most effective way to compare changes is to use digital photography with a camera that automatically puts date and time information on the photo. These photos should be taken in the same positions so they can accurately be compared.

Internal examination of the throat is performed by using laryngoscopy. This diagnostic test is usually performed by a speech therapist trained in the use of this instrument to visually examine the interior of the larynx (voice box). 

TREATMENT

Because the neck transports blood to and from the brain, and since a clear airway is essential to breathing, this condition must be cleared as carefully as possible by a lymphedema therapist who has specialized training in this treatment.

• Manual lymph drainage is an important part of this treatment; however it must be performed so that the blood flow in and around the aorta located in the neck is not blocked.
• The water wheel is a collection of lymphatic vessels that is located slightly in front of, and below, the jaw. A circular massage motion in this area helps to stimulate the flow of lymph in this area.
• The lack of adequate saliva in the mouth results in a dry mouth and this requires massage within the mouth. For sanitary reasons, the therapist must wear disposable gloves when performing this type of massage.
• Compression face masks, neck and chin straps are specialized compression garments that  should be used only in the design, and size, as recommended by the patient’s therapist.
• Proper treatment can improve the patient’s quality of life; however, appropriate training and extreme caution in providing this treatment is very important.

REFERENCES

1. Parts of this article were contributed by
   Tina Hammond, PTA, CLT-LANA.
2. Lymphedema Cargiver's Guide by M.K.Kearse, PT, PT-CLT, E. McMahon, PhD, and A. Ehrlich, MA. Lymph Notes 2009, pages 16, 79, 99, 135, 146, and 310.

© LymphNotes.com 2014. This information does not replace the advice of a qualified healthcare professional.

Got a question or comment? Post in the 'How Lymphedema is Treated' forum.
Category: How Lymphedema is Treated Updated: 2014-10-07