A Narrative Review of Lymphedema Following Head and Neck Cancer Treatment

Head and neck lymphedema (HNL) is a common complication of head and neck cancer (HNC) treatment, with upwards of 70-90% of patients suffering from this condition. Surgery and radiation, the backbones of HNC treatment, disrupt lymphatic networks through direct injury and fibrosis, leading to accumulation of lymphatic fluid in interstitial spaces. This causes swelling of external and internal structures, leading to decreased quality of life, cosmetic distress, social withdrawal, and functional deficits such as dys-phagia, dysphonia, and reduced cervical mobility. Having a reliable assessment tool is key to diagnosing and monitoring HNL; however, few tools specific to HNL exist. Cur-rently, the cornerstone of HNL treatment is conservative management with complete decongestive therapy, which shows mixed efficacy. There is a lack of surgical options as well as prophylactic interventions. Imaging of lymphatic channels is a promising mo-dality that can help providers guide and plan personalized therapies. This paper provides a narrative review of the pathophysiology, assessment, and prevention of HNL, high-lighting future directions for improvement.