Lymphoedema

Head and neck oedema advice leaflet

Oedema of the head, face or neck is very noticeable and many people can find this distressing.

There are several risk factors which increase the incidence of developing oedema of the head, face or neck, these include:

  • Primary lymphoedema : swelling due to a com­promised lymphatic system often present from birth. Swelling can present in any area of the body though it is rare throughout the head and neck but is not unheard of.
  • Secondary lymphoedema : swelling due to an external cause e.g. surgery or injury Particular causes of secondary lymphoedema of the head and neck have been identified, these are:

 

Very high doses of radiotherapy Recurrent infection (acute inflammatory episode) Scar contracture – a permanent shortening of tissue e.g. skin or muscle, which often results in reduced mobility.

The treatment for head and neck oedema involves:

  1. External compression / hosiery This will be selected and fitted by your lymphoedema therapist. It is often in the form of a mask (you may be given a temporary mask at your initial assessment made of soft cotton and then referred to a specialist centre to have an alternative garment made). Compression works by providing a counterforce for the muscles to work against, resulting in improved lymphatic drainage and ultimately a reduction in swell­ing. This is also effective in the head, face and neck where muscles are very small. As well as hosiery, foam or padding may be used to reduce swelling. Soft foam may be cut to size and used to provide gentle compression to delicate areas e.g. eye sockets. You will be advised how, when and where to wear the mask and foam pieces and for how long.
  2. Manual Lymphatic Drainage Manual Lymphatic Drainage (MLD) is a very gentle type of skin massage carried out by a trained thera­pist. The techniques are designed to move the fluid away from the swollen area to drain freely elsewhere. For oedema of the head and neck, MLD can improve your physical appearance, by reducing the swelling. MLD also helps to make you generally more comfort­able by reducing local discomfort and fullness. The sessions usually last approximately 30 minutes and you may be required to undress to the waist (bras can be left on).
  3. Simple Lymphatic Drainage Simple Lymphatic Drainage (SLD) is a simplified version of MLD that you will be taught by your therapist to do yourself. It should be carried out twice daily and a part­ner/carer can become involved if you wish.
  4. Skincare This is important to stop the skin drying out and to re­duce the risk of infection. The skin should be washed daily and dried thoroughly. Moisturising cream should then be applied to external areas only, as directed by your therapist who will also advise you on what cream to use. You should pay particular attention to oral hygiene e.g. clean your teeth well, floss if appropriate and use a gentle mouthwash daily. Apply lip balm to prevent chapped/cracked lips, if this happens treat promptly. Any breaks in the skin should be treated with antiseptic cream.
  • Be careful with shaving, do not ignore nicks!! Apply antiseptic cream!
  • Avoid exposure to sunlight, use a high protection factor sunscreen and cover up!
  • Avoid insect bites, use insect repellent and if you do sustain a bite, treat with antiseptic!
  • Make your dentist aware of your condition and take good care of your mouth after any procedures.

 

5. Exercise

Exercise increases muscle pump activity, which can therefore lead to an increase in lymphatic uptake and a reduction in your swelling. Exercises should be car­ried out at least twice a day. The muscles in the face, head and neck are generally small. They can play a significant role in helping to reduce your swelling. Any facial expression makes the muscles work, so plenty of over exaggerated :

  • Frowning
  • Smiling
  • Yawning

Carry these out repeatedly at regular intervals, you may feel a bit silly to start with in front of anyone so do them on your own if you need to! You may also find chewing useful and this can provide an alternative exercise, which you can carry out in front of anyone, try sugar free gum. Exercise can also increase your range of movement. If you have reduced movement to your head and/or neck, caused by muscular damage, scar tissue and pronounced fibrosis exercise may help.

  • Gentle stretches looking left and right.
  • Moving the head up and down in a slow and controlled manner
  • Circling the head gently where possible.

Positioning – A soft collar to support your head and neck may be of benefit, please ask your therapist. We realise the delicate nature of having facial oedema. If you are having problems coming to terms with your changed appearance or indeed have other issues that you wish to discuss with an independent person please tell us and we can arrange for you to see one of our trained counsellors.

Wolverhampton Lymphoedema Service runs a support group for all patients with swelling, called the Black Country Support Network. Meetings are held the first Wednesday of every month at Compton Hospice. Ask your therapist if you wish to attend.

Handy Hints

  • Try not to wear tight clothes around your neck e.g collars, ties
  • Do your SLD and exercises, they really make a difference.
  • Sleep on a few pillows as this will help drainage.
  • Although we have little information regarding it’s effectiveness to reduce oedema, Transcutaneous Electrical Nerve Stimulation (TENS) is widely used as a method of pain relief. Some small inconclu­sive studies have found that as consequence of using TENS to combat facial, head and neck pain there has been a reduction in oedema. More evi­dence will be needed in order to prove the effec­tiveness of TENS in treating head and neck oedema but it may be a future option.

Useful Addresses Lymphoedema Support Network, St Lukes Crypt, Sydney Street, LONDON SW3 6NH Telephone : 0171 351 4480 Website: http://www.lymphoedema.org/lsn/ Black Country Lymphoedema Support Network, c/o The Cedars Lodge 39 Compton Road West, Compton, Wolverhampton WV39DW Telephone; 01902 774517