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Lin YS, Liu CJ, Chou CH. Lymphovenous Anastomosis for the External and Internal Types of Head and Neck Lymphedema: A Case Series and Preliminary Clinical Results. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5872. [PMID: 38841535 PMCID: PMC11152802 DOI: 10.1097/gox.0000000000005872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/17/2024] [Indexed: 06/07/2024]
Abstract
Background Head and neck lymphedema (HNL), including external and internal types, could be a possible consequence for patients who have received neck dissection and radiotherapy for head and neck cancer. Initially, the common presentations are heaviness or tightness, followed by swelling in appearance, or difficulty speaking and swallowing in internal edema cases. Lymphovenous anastomosis (LVA) is an established approach to treat extremity lymphedema. We hereby present our preliminary experience in using LVA to treat HNL. Methods Between March 2021 and January 2024, six patients with HNL were treated with LVA via a preauricular or submandibular incision of the obstructed side. Lymphedema Symptom Intensity and Distress Surveys-Head and Neck (LSIDS-H&N) were used for evaluation. In addition, for the external type, MD Anderson Cancer Center Head and Neck Lymphedema (MDACC HNL) rating scale was used for evaluation. For the internal type, Swallowing Quality of Life was used for evaluation. Results With an average follow-up period of 15.4 ± 15.9 months, LSIDS-H&N improved from 1.11 ± 0.54 to 0.44 ± 0.66 (P = 0.02). For patients with the external type, within an average follow-up period of 15 ± 16.1 months, the MDACC HNL rating scale improved from level 2 to 0 or 1a (P = 0.008). For patients with the internal type, within an average follow-up period of 21 ± 17.3 months, Swallowing Quality of Life improved from 130.5 ± 9.2 to 151 ± 19.8 (P = 0.5). Conclusions Based on our preliminary results, LVA could be a potential solution to both external and internal HNL.
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Affiliation(s)
- Ying-Sheng Lin
- From Division of Plastic and Reconstructive Surgery, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Ju Liu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Han Chou
- Department of Otolaryngology, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan
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Starmer H, Cherry MG, Patterson J, Young B, Fleming J. Assessment of Measures of Head and Neck Lymphedema Following Head and Neck Cancer Treatment: A Systematic Review. Lymphat Res Biol 2023; 21:42-51. [PMID: 35679595 DOI: 10.1089/lrb.2021.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Head and neck lymphedema is a common condition following head and neck cancer (HNC) treatment, with substantial functional morbidity. This systematic review aimed to (1) identify tools used to assess head and neck lymphedema in HNC patients and (2) determine their validity and reliability. Methods: Electronic and hand searches of Prospero, MEDLINE, Cochrane Library, and Embase were searched from their inception until April 2021, and hand searches were independently screened by two reviewers. Studies were included if they were available in English and measured lymphedema in adult HNC patients (aged ≥18 years). Data including psychometric characteristics were extracted and synthesized narratively, with the Quality Assessment of Diagnostic Accuracy Studies-2 and the COnsensus-based Standards for the selection of health Measurement INstruments checklists used to assess risk of bias. Results: Thirty-three studies, reporting 38 assessment tools, were included. Assessments included clinician rating scales, symptom inventories, size measures, measures of internal edema, radiographic and ultrasonographic measures, and quality-of-life measures. Of the 38 measures cited, only 11 had any degree of validation and reliability testing. Risk of bias varied among the different assessment tools. Conclusion: While many tools are used in the assessment of head and neck lymphedema, the majority of these tools lack validation and reliability data. Only one tool, the Head and Neck Lymphedema and Fibrosis Symptom Inventory, met criteria for strong quality assessment. Further efforts to establish a core set of metrics for this complex condition are warranted.
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Affiliation(s)
- Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.,Institution of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Mary Gemma Cherry
- Institution of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Joanne Patterson
- Institution of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Bridget Young
- Institution of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Jason Fleming
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
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Tsai KY, Liao SF, Chen KL, Tang HW, Huang HY. Effect of early interventions with manual lymphatic drainage and rehabilitation exercise on morbidity and lymphedema in patients with oral cavity cancer. Medicine (Baltimore) 2022; 101:e30910. [PMID: 36281150 PMCID: PMC9592419 DOI: 10.1097/md.0000000000030910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There are clinical and statistical inconsistencies regarding early intervention with manual lymphatic drainage (MLD). The purpose of this study was to compare the short-term effect of early interventions with rehabilitation exercise versus MLD and rehabilitation exercise in terms of pain, range of motion (ROM) and lymphedema in patients with oral cancer after surgery. METHODS A total of 39 patients who underwent surgery from December 2014 to December 2018 participated in this randomized single-blind study. There were 20 patients in the rehabilitation (R) group and 19 in the MLD (M) plus rehabilitation group. The R group received 30 minutes of rehabilitation intervention; and the M group received 30 minutes of MLD, in addition to 30 minutes of rehabilitation intervention in a work day. Clinical measures, including the visual analog pain scale (VAS), ROM of the neck and shoulder, ultrasonography and face distance for lymphedema, and the Földi and Miller lymphedema scales, were assessed before surgery, before intervention and when discharged from the hospital. RESULTS The VAS pain score, ROM of the neck, and internal and external rotation of the right shoulder were significantly improved after the interventions. Right-face distance (P = .005), and skin-to-bone distance (SBD) of the bilateral horizontal mandible and left ascending mandibular ramus were significantly improved after the interventions. Left lateral flexion of the neck (P = .038) and SBD of the right ascending mandibular ramus (P < .001) in the MLD group showed more improvement than that of the rehabilitation group. CONCLUSION Early intervention with MLD and the rehabilitation program were effective in improving ROM of the neck and controlling lymphedema in acute-phase rehabilitation. The preliminary findings suggest a potential therapeutic role for early intervention with MLD, in addition to rehabilitation exercise, in that they yielded more benefits in lymphedema control and improvement of ROM of the neck in acute care.
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Affiliation(s)
- Kuo-Yang Tsai
- Department of Oral and Maxillofacial Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Su-Fen Liao
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
- Division of Pediatric Rehabilitation, Changhua Christian Children’s Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- * Correspondence: Su-Fen Liao, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, No.135 Nanxiao Street, Changhua, 500 Taiwan (e-mail: )
| | - Kuan-Lin Chen
- Department of Physical Medicine and Rehabilitation, Yuan Rung Medical Corporation Yuan Sheng Hospital, Yuanlin city, Changhua County, Taiwan
| | - Hao-Wei Tang
- Department of Physical Medicine and Rehabilitation, Yumin Medical Corporation Yumin Hospital, Caotun Town, Nantou County, Taiwan
| | - Hsin-Ya Huang
- Branch of Physical therapy, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
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Fadhil M, Singh R, Havas T, Jacobson I. Systematic review of head and neck lymphedema assessment. Head Neck 2022; 44:2301-2315. [PMID: 35818729 DOI: 10.1002/hed.27136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022] Open
Abstract
Head and neck lymphedema (HNL) is an increasingly recognized complication of head and neck cancer and its treatment. However, no consensus exists on the "gold-standard" assessment tool for the purposes of diagnosis, classification, or monitoring of HNL. We conducted a systematic review of the literature regarding HNL assessment to determine the optimal method/s of assessment for patients with HNL. A review of publications between January 2000 and September 2021 was undertaken on four electronic databases. Studies were excluded if no clear assessment method of HNL was documented. Sixty-seven articles were included in the study. A wide range of assessment methods for HNL have been reported in the literature. For the purposes of diagnosis and classification of physical findings, computed tomography (CT) appears the most promising tool available for both external and internal HNL. In terms of monitoring, ultrasound appears optimal for external HNL, while a clinician-reported rating scale on laryngoscopy is the gold standard for internal HNL. Patient-reported assessment must be considered alongside objective methods to classify symptom burden and monitor improvement with treatment.
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Affiliation(s)
- Matthew Fadhil
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ravjit Singh
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, New South Wales, Australia.,Department of Otolaryngology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Thomas Havas
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, New South Wales, Australia.,Department of Otolaryngology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ian Jacobson
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, New South Wales, Australia.,Department of Otolaryngology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Preliminary evaluation of reliability and validity of head and neck external lymphedema and fibrosis assessment criteria. Eur J Oncol Nurs 2016; 22:63-70. [DOI: 10.1016/j.ejon.2016.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/23/2016] [Accepted: 02/01/2016] [Indexed: 11/20/2022]
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Deng J, Ridner SH, Aulino JM, Murphy BA. Assessment and measurement of head and neck lymphedema: State-of-the-science and future directions. Oral Oncol 2015; 51:431-7. [DOI: 10.1016/j.oraloncology.2015.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 01/08/2023]
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EDGE Task Force on Head and Neck Cancer Outcomes A Systematic Review of Outcome Measures for Quantifying External Lymphedema. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533020-00004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Deng J, Ridner SH, Murphy BA. Lymphedema in Patients With Head and Neck Cancer. Oncol Nurs Forum 2010; 38:E1-E10. [DOI: 10.1188/11.onf.e1-e10] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lewin JS, Hutcheson KA, Barringer DA, Smith BG. Preliminary Experience With Head and Neck Lymphedema and Swallowing Function in Patients Treated for Head and Neck Cancer. ACTA ACUST UNITED AC 2010. [DOI: 10.1044/sasd19.2.45] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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.
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Affiliation(s)
- Jan S. Lewin
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer CenterHouston, TX
| | - Katherine A. Hutcheson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer CenterHouston, TX
| | - Denise A. Barringer
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer CenterHouston, TX
| | - Brad G. Smith
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer CenterHouston, TX
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