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Lymphedema Care 

Submental and Facial Edema
After Head and Neck Cancer Treatment

After treatment for head and neck cancer, many people experience swelling under the chin, along the jawline, or in the face. This condition, called submental and facial lymphedema, happens when lymph fluid cannot drain properly due to surgery, radiation, or scarring.

Although common, it can be managed effectively with therapy, self-care, and compression devices.

Why Does It Happen? (Causes):

  • Surgery: Removal of lymph nodes or tissue disrupts normal lymph drainage (Smith et al., 2015).

  • Radiation Therapy: Radiation causes scarring and fibrosis in soft tissues and lymph vessels (Ridner et al., 2016).

  • Scarring and Fibrosis: Tissue stiffening after treatment can block fluid movement, especially under the chin (Smith et al., 2015).

  • Gravity and Positioning: Fluid tends to collect when lying down or looking downward (Smith et al., 2015).

How Common Is It?:

  • Up to 75% of head and neck cancer survivors develop some form of lymphedema (Ridner et al., 2016).

  • About half of these cases involve visible external swelling in the face or neck, while others occur internally in the throat (Deng et al., 2012).

  • Edema may begin weeks to months after treatment and can persist without treatment (Deng et al., 2012).

Treatment Approach:

Complete Decongestive Therapy (CDT): The Gold Standard

The International Society of Lymphology (2020) recommends CDT as the most effective management for lymphedema. CDT includes four pillars:

  1. Manual Lymph Drainage (MLD)

    • Gentle massage to move fluid toward healthy drainage areas.

    • Can be performed by a trained physical therapist and adapted for self-care.

  2. Compression Therapy

    • Specialized garments, straps, masks, or devices to maintain pressure and prevent fluid buildup.

    • Essential to keep results after massage or exercise.

  3. Exercise

    • Gentle facial, neck, and shoulder movements stimulate lymph flow.

  4. Skin Care

    • Protects skin from dryness or infection, which are risks in swollen tissue.

 

How Physical Therapy Fits Into CDT

A physical therapist trained in lymphedema care helps patients carry out CDT safely and effectively:

  • Performs MLD techniques and teaches simplified versions for home use.

  • Guides neck, jaw, and shoulder exercises to keep mobility and reduce stiffness.

  • Recommends and fits compression garments and devices tailored to the patient.

  • Advises on posture and sleep positioning (for example, elevating the head during sleep).

 

How Self-Management Fits Into CDT

Daily self-care is key for long-term control:

  • Self-massage (simple MLD): Gentle strokes under the chin and along the neck.

  • Positioning: Sleeping with head elevated; avoiding long periods looking downward.

  • Facial exercises: Smiling, puffing cheeks, tongue and jaw movements.

  • Consistent compression use: Following therapist guidance for hours per day/night.

Compression Devices and Garments:

1. Chin Straps

  • Character: Wrap under chin and around the head; provide light-to-moderate compression.

  • Best for: Early or mild swelling, night use, or introduction to compression.

  • Popular examples:

    • JOBST® Chin Strap – soft fabric, adjustable.

    • JoviPak® Chin Strap – includes foam pads for more contour.

    • Sigvaris ChipPad® Chin Strap – adds microfoam chips to soften fibrosis.

 

2. Custom Facial Masks (Flat-Knit or Custom-Made)

  • Character: Designed for individual face/neck shape; provide stronger, firmer containment.

  • Best for: Moderate-to-severe swelling, irregular shapes, or long-term management.

  • Popular examples:

    • Medi 550 Flat-Knit Custom Face Mask – very firm, durable.

    • JOBST® Elvarex® Custom Facial Garment – reliable, flat-knit design.

    • Juzo Expert® Face Mask – softer flat-knit, more comfortable for sensitive skin.

 

3. Garments with Foam or Padding Inserts

  • Character: Apply targeted pressure to hardened/fibrotic tissue; often combined with chin straps or masks.

  • Best for: Radiation fibrosis or firm swelling.

  • Popular examples:

    • JoviPak® Face Mask with Inserts – customizable foam inserts.

    • Tribute® Wrap Neck & Face – soft, night-time option with foam.

    • Swedish ChipPad® Inserts – placed under garments for added pressure.

 

4. Pneumatic Compression Devices (Advanced)

  • Character: Inflatable garments provide cycles of gentle, controlled pressure.

  • Best for: Moderate-to-severe or persistent swelling; patients who need more than garments alone.

  • Popular examples:

    • Flexitouch® Plus Head & Neck System – designed specifically for head/neck.

    • Lympha Press® PCD-Eln – multi-chamber inflation for contour fit.

    • ArtAssist® Pump with Custom Facial Garment – less common, but available in some clinics.

  • Pros/Cons: Highly effective, but expensive and require training.

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Summary:

​Submental and facial lymphedema is a common but manageable side effect of head and neck cancer treatment. It happens because of surgery, radiation, or scarring that blocks normal lymph flow. The most effective approach is Complete Decongestive Therapy (CDT), which combines massage, compression, exercise, and skin care. Physical therapists guide patients in CDT, while self-management ensures success at home. Compression choices range from simple chin straps to custom masks and advanced pneumatic pumps, each with unique benefits. With the right combination, patients can reduce swelling, restore comfort, and regain confidence in daily life.

Scientific References:

  • Deng, J., Ridner, S. H., Dietrich, M. S., Wells, N., Wallston, K. A., Sinard, R. J., Cmelak, A. J., & Murphy, B. A. (2012). Prevalence of secondary lymphedema in patients with head and neck cancer. Journal of Pain and Symptom Management, 43(2), 244–252. https://doi.org/10.1016/j.jpainsymman.2011.03.018

  • International Society of Lymphology. (2020). The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology, 53(1), 3–19.

  • Ridner, S. H., Dietrich, M. S., Niermann, K., Cmelak, A., Mannion, K., & Murphy, B. (2016). A prospective study of lymphedema in head and neck cancer patients. Laryngoscope, 126(6), 1264–1269. https://doi.org/10.1002/lary.25754

  • Smith, B. G., Lewin, J. S., & Chambers, M. S. (2015). Lymphedema management in head and neck cancer. Current Opinion in Otolaryngology & Head and Neck Surgery, 23(2), 153–160. https://doi.org/10.1097/MOO.0000000000000136

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