Two Different Physiotherapy Programs in Lymphedema Following Head and Neck Cancer Treatment
Two Different Physiotherapy Programs in Lymphedema Following Head and Neck Cancer Treatment
The aim of this study was to determine the effects of complex decongestive physiotherapy
 (CDP) and home programs on internal/external lymphedema, staging, fibrosis, and
 three-dimensional (3D) surface scanning and volume evaluation in head and neck lymphedema.
 Twenty-one patients were randomly divided into three groups: CDP; home program including self
 manual lymph drainage (MLD) and exercises; and control. CDP included MLD drainage,
 compression, exercise, and skin care. Self-MLD and exercises were performed by home program
 group patients. Assessment methods were applied at baseline and 4 weeks later for all groups.
 MD. Anderson Cancer Center Head and Neck Lymphedema Protocol was implemented to evaluate head
 and neck external lymphedema, staging, and fibrosis. An Artec Eva 3D scanner and the Autodesk
 ReCap Photo Studio software were used to determine and calculate the volume of the head and
 neck region via 3D surface scanning. Head and neck external lymphedema and fibrosis
 assessment criteria were performed to evaluate visible soft tissue edema and the degree of
 stiffness. To assess internal lymphedema, Patterson's scale was applied using fiber-optic
 endoscopic imaging.
Head and neck cancer (HNC) have been seen in 13.3/100,000 males and 2.8/100,000 in females in
 Turkey. HNC related treatments such as lymph node dissection, tumor excision, chemotherapy,
 radiotherapy, and cancer itself can cause head and neck lymphedema (HNL). The incidence of
 HNL due to HNC treatments (surgery, chemotherapy and chemoradiation) has been reported to be
 between 48% and 90%.

 A recognition of HNL has been growing in recent years, but HNL is still much less recognized
 than upper and lower limb lymphedema and is easily ignored by both patients and health care
 providers. Therefore, in many cases, the diagnosis and treatment of HNL may be delayed, or
 patients cannot access treatment. In routine practice, after HNC, the self-absorption of HNL
 is generally expected. Clinical experiences have confirmed that HNL develops 2-6 months after
 cancer treatment and regresses in some patients over time.

 A variety of physiotherapy approaches have been shown to prevent and minimize physical,
 functional, emotional, and social disorders resulting from HNL. However, complex decongestive
 physiotherapy (CDP) is considered a gold standard treatment method for lymphedema. This
 method consists of manual lymph drainage (MLD), skin care, compression therapy, and
 therapeutic exercises. Although there are many studies about the effects of CDP on upper and
 lower limbs, there is only a limited number of studies about HNL and CDP in the literature.
Inclusion Criteria:

 -  >18 years old

 -  had unilateral/bilateral neck dissection

 -  had received radiotherapy and/or chemotherapy

 -  elapsed time of 3 or more months since cancer treatments

 -  had secondary HNL

 Exclusion Criteria:

 -  having metastases due to HNC or other primary cancers

 -  receiving/having received treatment to regulate the lymph flow

 -  having the diagnosis of neurological, orthopedic, or rheumatologic diseases that may
 cause circulation and movement in the head and neck region.