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. 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 dysphagia, dysphonia, and reduced cervical mobility. In this narrative review, we provide a broad overview of the pathophysiology, assessment, and prevention of HNL. Key surgical factors include the extent of neck dissection, including specific levels removed. Radiation compounds surgical injury through lymphatic fibrosis in a dose-dependent manner. Emerging radiation de-escalation strategies may reduce HNL, though lymphedema is rarely studied as a trial endpoint. Moreover, assessment of HNL remains challenging due to the absence of a gold standard—patient-reported outcome measures, clinician-reported scales, and instrumental tests each capture distinct components of external and internal HNL. Currently, the cornerstone of HNL treatment is conservative management with complete decongestive therapy, which shows mixed efficacy and does not address internal HNL. Surgical options including lymphovenous anastomosis and vascularized lymph node transfer show early promise but remain limited to case reports and small series. Lymphatic imaging, particularly indocyanine green lymphography, represents a promising emerging modality for guiding personalized treatment planning, though application to the head and neck remains challenging. Ultimately, current management of HNL remains largely reactive, with a noticeable lack of preventative therapies. Future research may benefit from better defining surgical options, including HNL as an endpoint in radiation de-escalation trials, and validate emerging lymphatic imaging techniques in order to improve outcomes for HNC survivors.