Head and Neck Lymphedema

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 include visual signs of swelling or puffiness anywhere around the head, face, or neck; however they might also include not-so-visible signs so as:

• Trouble swallowing.
• The constant feeling of having a sore throat.
• Difficulty breathing.
• Pain when moving the neck and head into certain positions. Some of this is known as "referred pain" which is a term used to describe pain perceived at a distance from the location of an injury's origin This could result from adhesions, radiation, or surgical scars located in other parts of the body that seem to be totally unrelated to the painful areas. 
• Scalp pain or tenderness or tingling.
• Blurred vision, or tearing and redness of the eye, an ache behind the eye, or a twitching eye.
• Tinnitus (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, which is a 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 a clear airway is essential to breathing, treatment of this condition must be performed very carefully by a lymphedema therapist with 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.
• The lack of adequate saliva, requires massage within the mouth. For sanitary reasons, the therapist must wear disposable gloves when performing this type of massage.
• Compression face Mmsks, 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 are very important.

References:

[1] Contributed by Tina Hammond, PTA, CLT-LANA.

[2] Lymphedema Management: The Comprehensive Guide for Practitioners 2nd ed. J.E. Zuther. Thieme 2009.

[3] Lymphedema of the Head and Neck: An Overview by Sheila H. Ridner, PhD, RN, ACNP. Lymph Links Vol 20, No 4 October-December 2008 pages 1-3.

[4] 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 2009. This information does not replace the one-on-one advice of a qualified health care professional.