Case report: head and neck lymphedema

The patient is a woman diagnosed with anaplastic thyroid cancer/metastatic differentiated carcinoma, with a previous history of lymphoma. She was very proactive in seeking treatment. She had retired shortly before her diagnosis and was enjoying retirement hobbies such as travel, gardening and home maintenance projects. At the start of therapy, her lymphedema was rated stage 1a on the MD Anderson Cancer Center (MDACC) rating scale: soft, visible edema, no pitting, reversible.

Methods

The aim of therapy was to reduce post-operative swelling as well as the stiffness and fibrosis caused by chemotherapy and radiotherapy.

Therapy started 7 weeks after radiotherapy. LymphaTouch treatment was given once a week alongside regular lymphedema therapy: manual lymphatic drainage (MLD), Kinesio taping, compression therapy with foam inserts and self-lymphatic drainage (SLD). The patient reported good adherence to compression therapy but poor adherence to SLD. She attended her clinic therapy sessions very consistently.

LymphaTouch settings and techniques

• Pulse mode with the default pulsation interval
• Pressure range 80-120 mmHg
• 80 mm, 50 mm and 35 mm cups

Techniques included stationary and sliding techniques with the 80-60 mm cups for swelling, followed by the lift and twist technique with the 50 mm cup on fibrotic tissue.

Results

Swelling was measured with ALOHA circumference measurements (Assessment of Lymphoedema of Head and Neck). Circumference was measured before the intervention (12 June 2020), after the intervention (23 July 2020) and at a follow-up visit (19 August):

• Lower neck: 41.5 cm before, 36.7 cm after, 37.6 cm at follow-up
• Upper neck: 44.4 cm before, 40.8 cm after, 39.0 cm at follow-up
• Ear to ear: 25.4 cm before, 24.0 cm after, 24.0 cm at follow-up

Swelling was also rated on the MDACC lymphedema rating scale. The patient's rating remained at the same level as at the start: stage 1a, soft visible edema, no pitting, reversible.

Before the intervention

After the intervention

Range of movement: Neck range of movement was assessed visually. Rotation improved by an estimated 50% and lateral flexion by an estimated 20% compared with the initial assessment. Before the intervention, movement in both directions was more restricted towards the left than towards the right.

Skin: Radiation-induced telangiectasia was visible over the supraclavicular area and the medial chest wall above the subpectoral nodal area (see photos). Over the six-week period, the colour and swelling in this area appeared to reduce and contract.

Patient comment

The patient said the therapeutic feel of the device was pleasant and acceptable, and that it gave her improved range of motion after each session. She particularly liked LymphaTouch therapy in conjunction with the other usual forms of lymphedema therapy.

Case report from Chris O'Brien Lifehouse, Sydney, Australia. Sandra Templeton, Occupational Therapist and Senior Lymphedema Specialist.