Compromised cervical lymphatic drainage following lymphadenectomy and radiation: an overview of head and neck lymphedema and its emerging pathophysiological implications

The critical function of the lymphatic system is to support tissue homeostasis through clearance of interstitial fluid. Lymphatic drainage from the head and neck tissues converges at the cervical lymphatic system, the central gateway through which lymph enters the peripheral blood. Surgical resection of neck lymph nodes and destruction of lymphatics by radiotherapy impedes lymph clearance, and the accumulation of metabolic waste and inflammatory cells affects the physiological function of various tissues dependent on neck lymphatics for drainage. Unlike breast cancer, lymphedema in head and neck cancer patients is under-reported due to the complexity of its presentation and limited standardized diagnostic instruments. For this review, the PubMed, Embase, and Cochrane Library databases were searched from inception to December 2025 using the combination of terms “head and neck lymphedema” and “cancer” , and the results were curated based on evidence and clinical relevance. This review integrates our current understanding of head and neck lymphedema (HNL), including pathophysiology, disease staging, assessment tools, current management and promising treatment advances, and emerging evidence of potential adverse effects on distant tissues of the head and neck. The impact of lymphedema on cutaneous and mucosal structures as well as other head and neck tissues increases the burden on the patient's quality of life. Head and neck oncologists are uniquely positioned to detect early lymphedema changes and direct care for timely multidisciplinary interventions to mitigate pathological progression to irreversible tissue changes.