Head and Neck Lymphedema: An Underrecognized Contributor to Swallowing and Airway Impairments
Head and neck lymphedema (HNL) is a highly prevalent yet frequently underrecognized complication associated with head and neck cancer (HNC). Despite its significant impact on physical function, airway integrity, swallowing, and quality of life, HNL remains underdiagnosed and undertreated in many clinical settings.
Lymphedema is defined as a collection of protein-rich fluid within the interstitium. Secondary lymphedema may occur as a result of systemic disease, trauma, surgery, or cancer treatment (Grada & Phillips, 2017). In the head and neck cancer population, the development of lymphedema is remarkably common. Current research demonstrates that approximately 96% of individuals with HNC develop moderate to severe lymphedema following treatment (Jeans et al., 2023).
HNL may present externally, internally, or as a combination of both. External lymphedema often involves visible swelling of the face, neck, or submental region, while internal lymphedema may impact structures of the pharynx and larynx. Importantly, both forms are associated with significant physical, functional, and psychological consequences (Jeans et al., 2021).
As described by Stubblefield and Weycker (2023), “Though HNL is common and potentially contributory to other function-limiting issues in this population, it is notoriously understudied, underrecognized, underdiagnosed, and under-treated.”
The clinical implications of HNL are extensive. Individuals may experience skin changes, pain, reduced range of motion, contracture, trismus, dysarthria, dyspnea, postural abnormalities, airway obstruction, visual changes, and diminished quality of life (Jeans et al., 2023; Smith & Lewin, 2010; Stubblefield & Weycker, 2023).
From a swallowing perspective, HNL can significantly impair function. Research has demonstrated associations between HNL and increased penetration and aspiration events, greater need for diet modifications, and poorer patient-reported swallowing outcomes (Jeans et al., 2023; Smith & Lewin, 2010; Stubblefield & Weycker, 2023). Internal edema involving pharyngeal and laryngeal structures may negatively affect airway protection, bolus clearance, and overall swallowing efficiency.
Given these concerns, early identification and intervention are critical. Emerging evidence suggests that timely assessment and treatment of HNL may improve outcomes related to dysphagia, dyspnea, and pain in survivors of head and neck cancer (Gutiérrez et al., 2020; Ridner et al., 2019).
As awareness surrounding HNL continues to grow, there is an increasing need for interdisciplinary collaboration, improved screening practices, and proactive rehabilitation approaches. Greater recognition of HNL and its functional consequences may help improve long-term outcomes and quality of life for individuals living with and beyond head and neck cancer.
HNL visualized during endoscopy.