L&L Therapy Services, LLC

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.

After radiation therapy (RT) or chemoradiation (CRT) therapy for head and neck cancer, some patients develop significant swallowing problems. This complication is thought to be a result of radiation induced damage and chronic alteration of tissues whereby the body reacts to the radiation by producing fibrosis. In some persons, this healing process seems to go awry, thus causing excess fibrosis and dysphagia. The major problem faced by patients with dysphagia is stiffness of tissue and underlying muscle weakness, causing reduced bolus clearance; hence, food is much more problematic than liquids. In fact, aspiration is rare unless the dysphagia is severe.

While compensatory treatment for dysphagia post C/RT is helpful, it is not rehabilitative. More permanent rehabilitative approaches use exercise regiments along with stretching. Massage, lymphedema therapy and electrical stimulation are sensory based or externally based treatments that also are employed, but less frequently. Unfortunately, the efficacy of most treatment approaches is limited, and randomized clinical trials urgently are needed to guide clinicians who work with this population.

Previous thought was that total laryngectomy and difficulty with swallowing were incongruous. Patients were counseled that the loss of their larynx would leave them without a vocal source, but that swallowing would not be affected. Successful rehabilitation was defined as being cancer-free and regaining functional communication. Patients were not queried and frequently did not complain of dysphagia as long as they were able to maintain an oral diet. Knowledge has changed, and this article will focus on dysphagia in the patient with laryngectomy and will discuss anatomical sites to physiologic problems.

The combination of chemotherapy and radiation has emerged as a standard of care for patients diagnosed with head and neck cancer (HNC) of the oropharynx, the hypopharynx, and the larynx. Many devastating complications to the integrity of the swallow have been documented to occur with the swallowing mechanism, as a result of several chemoradiation protocols. These complications include decreased oral caloric intake, long-term reliance on feeding tubes for nutrition, weight loss, increased morbidity and mortality, decreased quality of life, and increased utilization of health-care services.