Lauren Meffen is a speech language pathologist with a passion for working with voice and swallow disorders. She has worked in a variety of settings including hospital, skilled nursing, home health and outpatient, private practice. At Wildflower Therapy, she provides individualized and quality care for each patient and family—with a specialty in working with the oncology population. She has advanced training in management of lymphedema of the head and neck, muscle tension dysphonia and myofascial release techniques. In the article below, she addresses common causes, risk factors and treatment of head and neck lymphedema.
What is head and neck lymphedema?
Swelling can occur during and after treatment of head and neck tumors. This swelling may be lymphedema, caused by a primary tumor, surgery or following radiation therapy. Lymphedema is staged, based on the feeling of the tissue, measurements and difficulties related to swallowing and speech. The most obvious location of visible swelling is the face and neck, called external edema. Swelling inside of the mouth, intraoral edema, is perhaps the most difficult type of edema that impacts speech. Internal edema can be found inside the throat and may result in difficulty swallowing. The side effects of swelling impact a patient’s quality of life by creating challenges to breathe, communicate, eat and drink. Treatment includes a series of manual lymph drainage strokes, often called “massage,” and wearing compression garments.
Lymphedema is not a preventable side effect, but your lymphedema therapist can anticipate swelling by understanding several factors at the start of radiation treatment. The first risk factor for lymphedema is the number of lymph nodes removed during surgery—the more lymph nodes removed, the higher the risk. The second risk factor is the location of the primary tumor site and understanding the surrounding lymphatics. Other important factors are the total dose of radiation and the number of days the patient attended radiation. The goal of lymphedema therapy is aimed to decrease the swelling and improve swallowing, speech and breathing.
How do you treat it?
Educating our patients on what lymphedema looks and feels like can improve the independent care and management of this diagnosis. Wearing compression is part of a patient’s complete decongestive therapy. Patients should wear compression for a minimum of 4 hours a day—we strongly encourage patients to wear their garment longer and while sleeping. This will correlate to decreased swelling externally, resulting in improved movement of the structures that help you speak and swallow.
There are a few things patients can do to help decrease swelling. Completing a series of exercises while wearing compression can help improve the movement of lymphatic fluid. Your therapist will likely recommend a series of exercises specific to your deficits. When lymphedema is managed, speech and swallowing improve.
Other modalities, such as lymphatic taping, can help manage head and neck lymphedema. Taping can improve the transport of lymphatic fluid from one region in the face or neck to another region in the body. Taping can be combined with wearing compression. Sleeping in a recliner, as upright as possible, also will aide in draining the collection of fluid.
The key in long-term management of lymphedema is working closely with your lymphedema therapist and medical team. With appropriate selection of treatment protocols, including manual lymph drainage, exercises and compression wear, you will see improvements in speech and swallowing function. Most importantly, your quality of life is dramatically increased with appropriate guidance.
References:
Deng J. Murphy B.A., et al. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status and quality of life. Head Neck. 2013 July 35 (7): 1026-1035.
Deng J, Ridner, SH, Dietrich, MS, Wells, N, Murphy, BA. Assessment of external lymphedema in patients with head and neck cancer: a comparison of four scales. Oncol Nurs Forum. 2013;40:501-506.
Smith B.G. and Hutcheson, K. A et al. Lymphedema outcomes in patients with head and neck cancer. Curr Opin Otolaryngology Head Neck Surg. 2014 Nov; (152;2) 284-291.
Smith B.G. and Lewin J.S. The role of Lymphedema management in head and neck cancer. Curr Opin Otolaryngology Head Neck Surg. 2010 June; 18 (3) 153-158.
Zuther, J . Pathology. In: Zuther, J, Norton, S, eds. Lymphedema Management: The Comprehensive Guide for Practitioners. New York, NY: Thieme; 2013:45-71.
Learn more about a lymphedema diagnosis after cancer treatment. View the variety of lymphedema aids Juzo has available to help manage swelling. Follow us on Instagram, @JuzoCompression and Facebook.