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Lymphedema of the Head

Like so many areas that may involve lymphedema, there has been little written or discussed in the medical record pertaining to head lymphedema. The incidence of head lymphedema has dramatically increased as our ability of detecting and treating cancer has sky rocketed.

Fortunately, there is not only treatment available for this, but compression garments as well. Included on our page is not only information regarding it, but a list of supplier of compression garments and supplies.

Lymphedema of the head is generally caused by removal of lymph nodes for cancer biopsy. Other causes may include surgical removal of tumors, infections (cellulitis, lymphangitis, lymphadenitis), radiation damage to existing lymph nodes and medications indicated for hypertension. In rare cases neck edema and/or lymphedema may be caused by tumors, cystic hygromas or other growths.

While most swelling is resolved by treatment of the underlying or causative medical condition, there are times when the swelling becomes permanent.

Related Terms Head edema, Facial edema, Eyelid Edema, Head lymphatics


If the swelling becomes permanent, whether the cause is known or unknown, the diagnoses of lymphedema must be considered.

What is Lymphedema?

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.

How is Lymphedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual lymphatic drainage (MLD), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

Manual lymphatic drainage plus compression bandaging, lymph node stimulation (clearance), exercises are indicated for lymphedema. See our revised page Treatment for a full description of treatment methods.

What are some of the complications of lymphedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immunodeficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations

Can lymphedema be cured - what is the long term prognosis?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

Lymphedema in Head and Neck Cancer

Because lym­phedema is a late effect of head and neck can­cer and its treat­ment, occur­ring well after a patient has com­pleted treat­ment, it is often over­looked, although it occurs fairly com­monly. For­mal reports on its inci­dence in the United States are not avail­able, but based on Euro­pean research, researchers esti­mate its occur­rence to vary from 12%–54%. Lym­phedema in the head and neck can cause dis­tress­ing symp­toms that inter­fere with patients’ qual­ity of life and body image.

In their arti­cle in the Jan­u­ary 2011 Oncol­ogy Nurs­ing Forum, Deng, Rid­ner, and Mur­phy described the risk fac­tors for and pre­sen­ta­tion, mea­sure­ment, and man­age­ment of lym­phedema after head and neck can­cer treat­ment. The oncol­ogy nurse’s role in man­ag­ing patients with this con­di­tion, as well as in future research into the con­di­tion, is also discussed.

Lym­phedema of the Head and Neck

Lym­phedema can involve both inter­nal and exter­nal struc­tures in the head and neck. Exter­nal symp­toms can result in decreased range of motion in the neck and shoul­ders, which can affect qual­ity of life and abil­ity to per­form activ­i­ties of daily liv­ing. Severe exter­nal symp­toms can cause vis­i­ble swelling in the face, neck, and shoul­ders, which affects patients’ qual­ity of life and body image, some­times lead­ing to depres­sion, self-​​isolation, and social avoidance.

Inter­nal symp­toms involve struc­tures such as the tongue, lar­ynx, and phar­ynx. Lym­phedema in these areas can result in dif­fi­culty speak­ing, swal­low­ing, and breath­ing, impact­ing patients’ qual­ity of life and nutri­tion status.

Based on the results of two stud­ies reported in the lit­er­a­ture, Deng et al. con­cluded that tumor stage, radi­a­tion dose, and sur­gi­cal dis­rup­tion of the lym­phatic sys­tem all place patients at risk for devel­op­ing lym­phedema. Other fac­tors also have been thought to result in lym­phedema, such as comor­bid con­di­tions, smok­ing, and lifestyle or occu­pa­tion, but these have not been stud­ied in clin­i­cal trials.

See remainder of article - ONS Connect

As Seen in the Oncology Nursing Forum [By Elisa Becze, BA, ELS, ONS Staff Writer]

π-Shaped lymphaticovenular anastomosis for head and neck lymphoedema: A preliminary study.

Oct 2012

Ayestaray B, Bekara F, Andreoletti JB.

Source Department of Plastic and Reconstructive Surgery, Nimes University Hospital, pl Pr Robert Debré, 30000 Nimes, France; Department of Plastic and Reconstructive Surgery, Breast Institute, 15, av Jean Jaurès, 90000 Belfort, France. Electronic address:



Head and neck lymphoedema secondary to jugular lymphadenectomy is a severe issue, without efficient solution. Successful treatment of lymphoedema of the upper and lower limbs has become possible with supermicrosurgical lymphaticovenular anastomosis. The technique based on two end-to-side anastomosis is named π-shaped lymphaticovenular anastomosis. We have evaluated this method for chronic head and neck lymphoedema.


From November 2010 to April 2011, four patients with a chronic head and neck lymphoedema were treated by π-shaped lymphaticovenular anastomosis. Three patients had a unilateral lymphoedema, and one patient had a bilateral lymphoedema. The mean age of the patients was 63.2 years (range, 46-77 years). The mean duration of the lymphoedema was 2.6 years (range, 1-5). Every patient was operated under local anaesthesia through a face-lift skin incision. One π-shaped lymphaticovenular anastomosis was performed at each operative site.


The average operative time to perform one π-shaped lymphaticovenular anastomosis was 1.9 h (range, 1.8-2.5). The calibre of lymphatic vessels used for lymphaticovenular anastomosis ranged from 0.3 to 0.7 mm (average, 0.5). A venous back-flow was found in seven lymphaticovenular anastomosis (70%). Three patients (75%) had a qualitative improvement of skin tissue and a significant circumferential reduction after surgery. The average circumferential differential reduction rate was 3.7% (range, 0.6-7.8) (p = 0.006). The average cross-sectional area differential reduction rate was 7.2% (range, 1.2-15.1) (p = 0.007). The average volume differential reduction rate was 6.9% (range, 2-14.8) (p = 0.05).


The authors present a new option to treat head and neck lymphoedema. π-Shaped lymphaticovenular anastomosis is an effective method to reduce the severity of skin tissue fibrosis and lymphoedema volume. Further studies with larger groups of patients are required to confirm the outcome of this preliminary study. EBM Level = level 4.

Journal of Plastic, Reconstructive & Aesthetic Surgery

Abstracts and Studies

Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life.

Deng J, Murphy BA, Dietrich MS, Wells N, Wallston KA, Sinard RJ, Cmelak AJ, Gilbert J, Ridner SH.


School of Nursing, Vanderbilt University, Nashville, Tennessee.


BACKGROUND: Lymphedema may disrupt local function and affect quality of life (QOL) in patients with head and neck cancer. The purpose of this study was to examine the associations among severity of internal and external lymphedema, symptoms, functional status, and QOL in patients with head and neck cancer.

METHODS: The sample included 103 patients who were ≥3 months after head and neck cancer treatment. Variables assessed included severity of internal and external lymphedema, physical/psychological symptoms, functional status, and QOL.

RESULTS: Severity of internal and external lymphedema was associated with physical symptoms and psychological symptoms. Patients with more severe external lymphedema were more likely to have a decrease in neck left/right rotation. The combined effects of external and internal lymphedema severity were associated with hearing impairment and decreased QOL.

CONCLUSIONS: Lymphedema severity correlates with symptom burden, functional status, and QOL in patients after head and neck cancer treatment. Head Neck, 2012.


Factors Associated With External and Internal Lymphedema in Patients With Head-and-Neck Cancer May 2012

Deng J, Ridner SH, Dietrich MS, Wells N, Wallston KA, Sinard RJ, Cmelak AJ, Murphy BA. Source

School of Nursing, Vanderbilt University, Nashville, Tennessee.


PURPOSE: The purpose of this study was to examine factors associated with the presence of secondary external and internal lymphedema in patients with head-and-neck cancer (HNC).

METHODS AND MATERIALS: The sample included 81 patients ≥3 months after HNC treatment. Physical and endoscopic examinations were conducted to determine if participants had external, internal, and/or combined head-and-neck lymphedema. Logistic regression analysis was used to examine the factors associated with the presence of lymphedema.

RESULTS: The following factors were statistically significantly associated with presence of lymphedema: (1) location of tumor associated with presence of external (P=.009) and combined lymphedema (P=.032); (2) time since end of HNC treatment associated with presence of external (P=.004) and combined lymphedema (P=.005); (3) total dosage of radiation therapy (P=.010) and days of radiation (P=.017) associated with the presence of combined lymphedema; (4) radiation status of surgical bed was associated with the presence of internal lymphedema, including surgery with postoperative radiation (P=.030) and (salvage) surgery in the irradiated field (P=.008); and (5) number of treatment modalities associated with external (P=.002), internal (P=.039), and combined lymphedema (P=.004). No demographic, health behavior-related, or comorbidity factors were associated with the presence of lymphedema in the sample.

CONCLUSIONS: Select tumor and treatment parameters are associated with increased occurrence of lymphedema in patients with HNC. Larger and longitudinal studies are needed to identify adjusted effects and causative risk factors contributing to the development of lymphedema in patients with HNC.

Radiation Oncology

Cutaneous lymphatics and chronic lymphedema of the head and neck. Jan 2012

Keywords: solid facial edema; acne rosacea; Morbus Morbihan; acne vulgaris; lymphoscintigraphy

Feely MA, Olsen KD, Gamble GL, Davis MD, Pittelkow MR.


Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota.


Extensive attention has been directed to lymphedema involving the extremities. However, there has been relatively limited study of the cutaneous lymphatics of the head and neck. In this review of head and neck lymphatics, we capsulize the history of the lymphatics, the anatomy of the cutaneous lymphatics, lymphatic function and physiology, and imaging modalities used to define this intricate vascular system. To appreciate the clinical challenges associated with head and neck lymphatic dysfunction, we also provide an overview of disease processes of the cutaneous lymphatics and their treatment, theories on the etiology of lymphedema, and future directions to better understand lymphatic function and disease. Knowledge of the cutaneous lymphatics of the head and neck are critical to the clinical evaluation of patients, who present with this debilitating condition and to our understanding of its pathogenesis and appropriate management. Clin. Anat. 25:72-85, 2012. Wiley Periodicals/PubMed

Preliminary development of a lymphedema symptom assessment scale for patients with head and neck cancer. Nov 2011

Deng J, Ridner SH, Murphy BA, Dietrich MS.


School of Nursing, Vanderbilt University, 461 21st Ave. South, 600B Godchaux Hall, Nashville, TN, 37240, USA,

Keywords: Secondary lymphedema – Head and neck cancer (HNC) – Symptom assessment – Instrument development – Late effect


PURPOSE: Currently, no instruments are available to assess symptoms secondary to lymphedema in patients with head and neck cancer (HNC). The study aim was to develop and conduct preliminary tests of such an instrument.

METHODS: A preliminary item pool was generated from a literature review, previous work in breast cancer-related lymphedema, and an observational study. The item pool was revised based on an expert panel's suggestions and feedback from 18 patients with HNC. The current questionnaire, the Lymphedema Symptom Intensity and Distress Survey-Head and Neck (LSIDS-H&N), was then pilot tested in 30 patients with HNC.

RESULTS: Preliminary testing (1) demonstrated feasibility, readability, and ease of use of the LSIDS-H&N and (2) identified that there was a considerable level of symptom burden in the cohort of patients in the piloting sample.

CONCLUSION: Content validity of the LSIDS-H&N was supported by the expert panel during development of the LSIDS-H&N. Further testing is ongoing. Springer

Prevalence of Secondary Lymphedema in Patients with Head and Neck Cancer. Jul 2011

Deng J, Ridner SH, Dietrich MS, Wells N, Wallston KA, Sinard RJ, Cmelak AJ, Murphy BA.


School of Nursing, Vanderbilt University, Nashville, Tennessee, USA.

Key Words: Secondary lymphedema; head and neck cancer; prevalence; late effect


CONTEXT: Because surgery, radiation, and/or chemotherapy disrupt lymphatic structures, damage soft tissue leading to scar tissue formation and fibrosis, and further affect lymphatic function, patients with head and neck cancer may be at high risk for developing secondary lymphedema. Yet, no published data are available regarding the prevalence of secondary lymphedema after head and neck cancer treatment.

OBJECTIVES: The aim of this study was to examine prevalence of secondary lymphedema in patients with head and neck cancer.

METHODS: The study included 81 patients with head and neck cancer who were three months or more post-treatment. External lymphedema was staged using Foldi's lymphedema scale. Internal lymphedema was identified through a flexible fiber-optic endoscopic or mirror examination. Patterson's scale was used to grade degrees of internal lymphedema.

RESULTS: Of the 81 patients, 75.3% (61 of 81) had some form of late-effect lymphedema. Of those, 9.8% (6 of 61) only had external, 39.4% (24 of 61) only had internal, and 50.8% (31 of 61) had both types.

CONCLUSION: Lymphedema is a common late effect in patients with head and neck cancer, and it develops in multiple external and internal anatomical locations. During physical examination and endoscopic procedures, clinicians should assess patients with head and neck cancer for late-effect lymphedema. Referral for treatment should be considered when lymphedema is noted. Research is needed to examine risk factors of lymphedema in patients with head and neck cancer and its effects on patients' symptoms, function, and quality of life.

U.S. Cancer Pain Relief Committee\Elsevier

Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema.

Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.


Division of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The University of Texas Health Science Center, Houston, Texas, USA.



Lymphedema is a complication that may occur after surgical resection and radiation treatment in a number of cancer types and is especially debilitating in regions where treatment options are limited. Although upper and lower extremity lymphedema may be effectively treated with manual lymphatic drainage (MLD) therapies and devices that use compression to direct proximal flow of lymph fluids, head and neck lymphedema is more challenging.

METHODS AND RESULTS: Herein, we describe the compassionate use of an investigatory technique of near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy and function, help direct MLD, and use 3-dimensional (3D) surface profilometry to monitor response to therapy in a patient with head and neck lymphedema after surgery and radiation treatment.

CONCLUSION: NIR fluorescence imaging provides a mapping of functional lymph vessels for direction of efficient MLD therapy in the head and neck. Additional studies are needed to assess the efficacy of MLD therapy when directed by NIR fluorescence imaging.


Special Note for Head Lymphedema

The tenth NLN (national Lymhpedema Network) Conference from September 5-9, 2012 will feature a special seminar for head and neck lymphedema:

[H5]Advanced Management: The Complex Patient with Head and Neck Lymphedema Brad Smith, CCC-SLP, CLT Sheila Ridner, PhD, RN, FAAN Jie Deng, RN, PhD, OCN

Description: While current treatment for cancers of the head and neck are typically effective in controlling the disease process, they often result in severe functional deficits and compromised quality of life. Often these patients undergo complex treatments combining surgery, radiation, and chemotherapies, all of which contribute to post-treatment performance deficits. Impairments of swallowing and communication, decreased cervical range of motion, postural changes, and impaired mobility of the upper extremity after cancer treatment are well documented. Patients with head and neck cancer often present with multiple comorbidities and complex symptom burden that create obstacles to provision of traditional lymphedema management services. Head and neck lymphedema is an area of increasing research interest. This session will address lymphedema evaluation and management strategies to address the needs of medically complex patients whose cases require modifications of traditional approaches. Topics will include:

Who is the medically complex patient? Modifications of evaluation and treatment strategies Complex compression strategies Symptom and palliative management Tricks and tips Objectives:

Participants will be able to identify and discuss differences in patient presentation and treatment between patients requiring basic vs more complex treatment methodologies. Participants will learn about complex facial compression garments, measurements, and how compression pads and garments can be safely and creatively applied for patients with severe head and neck lymphedema. Participants will be able to describe measurement techniques for internal and external head and neck lymphedema. Participants will be able to discuss strategies for symptomatic and palliative management of severe head and neck lymphedema.

For a complete conference outline please see:

Tenth NLN Conference

Self Massage for Face and Head

1. Clear lymph nodes at neck.

A. Clear both sides of neck

• Divide side of neck into 2 sections – below ear and above collar bone.
• Gently stretch skin downward 5 to 10 times in each section.

B. Clear Terminus (notch above the collar bone)

• Gently perform “circles” 5 to 10 times.

C. Clear back of neck

• Divide back of neck into 2 sections – at hair line and base of neck.
• Gently stretch skin downward 5 to 10 times in each section.
 D. Clear Terminus (notch above the collar bone)
• Gently perform “circles” 5 to 10 times.

2. Clear lymph nodes in front of the ear.

• Place fingertips on each check, closest to the ear.  
• Massage gently downward in this area, 5 to 10 times.

3. Clear lymph nodes at back of the ear.

• Place fingertips on the bone behind each ear.
• Massage gently downward 5 to 10 times.

4. Clear the temples on each side of the face.

• Place fingertips on temples.
• Massage gently downward 5 to 10 times.

5. Clear the underside of chin.

• Divide underside of chin into three sections on each side 
 of the face, from chin to jaw bone.
• Gently massage 5 to 10 times in each section, moving in 
 an outward direction.

6. Clear front of chin.

• Divide underside of chin into 3 sections on each side of the face, 
 chin to jaw bone.
• Gently massage 5 to 10 times in each section, moving in an 
 outward direction.

7. Clear area from nose to corners of mouth.

• Gently massage on each side of nose downward with fingertips 
 to corners of mouth 5 to 10 times.

8. Repeat clearing of nodes on sides of neck (see #1).

9. Clear the cheeks.

•  Gently massage front of cheeks (each side) downward toward

jaw line 5 to 10 times.

10. Repeat clearing of nodes on each side of the neck (see #1).

11. Clear the area below each eye.

•  Gently massage below eyes (on edge of bone) downward toward cheeks,

5 to 10 times each side.

12. Repeat massage of cheeks downward to chin (see #9).

13. Repeat clearing of nodes at sides of the neck (see #1).

14. Clear the nose.

• Divide each side of nose into three sections, starting at tip to bridge of nose. 
• Gently massage 5 to 10 times each section, moving in an outward direction

15. Clear the tear duct.

• Place one finger on each side of nose next to tear duct.
• Gently massage downward 5 to 10 times.

16. Clear the eyelid.

• Place one to two fingers on each eyelid.
• Gently massage outward 5 to 10 times.

17. Clear the eyebrow.

• Place one to two fingers on each eyebrow.
• Gently massage upward 5 to 10 times.

18. Repeat clearing the cheeks (#9), clearing in front of the ear (#2), clearing back of the ear (#3), and clearing side of neck (#1).

Aurora Health

External Links

Swollen Neck Lymph Nodes

Irbesartan-associated persistent edema of the eyelids, face, and neck - Case Reports

Journal of Drugs in Dermatology

Philip R. Cohen

December 2002

Morbidity of supraomohyoidal and modified radical neck dissection combined with radiotherapy for head and neck cancer. A prospective longitudinal study.

Jan 2012

Wiley Online

Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-neck cancer.

Sep 2011


Treatment options for head and neck lymphoedema after tumour resection and radiotherapy. Sep 2011


Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema. Nov 2010

Wiley Online

Severe cheek and lower eyelid lymphedema after resection of oropharyngeal tumor and radiation. Mar 2010

Lippincott, Williams & Wilkins

Preliminary Experience With Head and Neck Lymphedema and Swallowing Function in Patients Treated for Head and Neck Cancer 2011

Jan S. Lewin, Katherine A. Hutcheson, Denise A. Barringer and Brad G. Smith

American Speech-Language-Hearing Association

Deep Neck Spaces and Infections

Elizabeth J. Rosen, MD and Byron J. Bailey, MD


Slides and Commentary

Neck Lymphedema and Compression Dr. Tony Reid - Dr. Reid's Corner

Dr.Tony Reid

Head and Neck Compression Garments

These types of garments always need to be custom made, the following vendors offer products:.

Lymphedema in Head and Neck Cancer


Solaris - Tribute Garments

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Updated June 23, 2012

lymphedema_of_the_head.txt · Last modified: 2012/10/16 14:40 (external edit)