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I have received several questions recently about the use of compression for treatment of edema of the neck and jaw. Both questions were from patients who suffered from cancer of the throat/tongue. Since I treat many of these patients, I am very familiar with the problems they encounter and I am very concerned about the use of compression for these patients. Edema is common after surgery and radiation for cancer anywhere in the throat or neck. The lymphatic system is disrupted by both radiation and surgery
resulting in the accumulation of excess edema. These patients suffer unsightly swelling and frequently have pain from the surgery and from the edema. While compression is very helpful for patients with edema of the extremities, it can be dangerous for patients with edema around the neck, throat or upper chest. Compression in and around the neck can result in compression of the carotid artery and can potentially lead to syncope (black outs), bradycardia (very slow heart rate) and strokes. Every medical stud
ent is taught to never apply even light pressure to both sides of the neck at the same time.
Most patients with edema of the neck area improve over a period of several months after the surgery and radiation is over. In fact, the skin usually becomes firm and leathery after the acute inflammation following radiation and surgery heals. In my practice, I do not use compression for edema of the neck area because I believe that the risks for the patient are too high. While edema is certainly a problem, living with a stoke is far worse.
Some patients have persistent edema or swelling that makes breathing or swallowing difficult. These patients need some form of medical intervention; however, in my experience this is very uncommon. When the edema becomes so bad that breathing or swallowing is compromised, I recommend a very careful evaluation by a surgeon, oncologist or other physician familiar with these problems. Since patients with cancer or elderly patients frequently have significant blockage of the carotid arteries due to cholesterol
, it is probably advisable to assess the extent of carotid artery blockage prior to the use of compression. An exam or CT scan is advisable to make certain that the problem is not due blockage of veins in the chest (superior vena cava syndrome). The vena cava syndrome is a very serious problem and should not be treated with compression.
Surgery can alter the anatomy of the neck, making it very difficult to know the exact effect of compression on blood flow in the arteries. Because of the altered anatomy, arterial blood flow could be diminished even when the compression is applied several centimeters away from the carotid artery. In my opinion, compression is rarely indicated for these patients but if compression is used it should only be applied to one side at a time. Bandages can be used to apply compression; however, it is very difficul
t to know the amount of pressure applied when bandages are used. In addition, any movement or turning of the head can change not only the position of the bandages but the amount of pressure applied and bandages slip and change position. I am unaware on any reputable devices specifically designed to apply compression safely to the neck area. If such a device exists, it would certainly have to be designed to apply compression to only one side at a time and be designed to avoid any possibility of compression
to the carotid artery. In summary, I feel that compression for edema around the neck is generally not warranted and could be potentially very dangerous. Any treatment of edema of the neck should be under the strict guidance of a physician after an evaluation to exclude vena cava syndrome and other causes of edema where compression would be contraindicated.
Tony Reid MD Ph.D
Modern Concepts In Identifying and Treating Lymphedema
On March 3rd and 4th of this year, the second lymphedema conference sponsored by Healthtronix Lymphedema Treatment Center will be held in Dallas Texas. This was an excellent conference last year and this year is posed to be a superb event as well. If you would like to read more on this upcoming event or register on line, click here or you can reach Healthtronix directly by phoning, 800-349-9490 or Dallas area 972-881-5535.
At the last Modern Concepts in Identifying and Treating Lymphedema Conference, Dr. Reid presented the results of several on line surveys. In this year's conference, Dr. Reid will be presenting the same surveys with updated results. I would like to extend our thanks and appreciation to all the patients who filled out the surveys, as this information is invaluable. Many patients turn to the results of these surveys to find information in areas where very little information is published or available.
If you have not have not filled out a survey and would like to participate, there are several surveys on line from our main page. The two surveys in particular that Dr. Reid will be presenting updated results on are Pregnancy and Lymphedema, and Breast Reconstruction and Lymphedema. (click on the links to participate). If either of these surveys are relevant to the reader's of eNews, they are available on line and your submitted data will be
included in the presentation at the March 2001 conference. Please note that the surveys are anonymous. Should you include any identifying information such as your name or email address, this is kept confidential and not released.
Another posted survey was MODERN CONCEPTS IN IDENTIFYING AND TREATING LYMPHEDEMA. As you can ascertain by the name, this was a survey posted on line directly after the first conference. During the course of the conference last year, Dr. Reid had the opportunity to ask therapists and patients about their feelings regarding lymphedema and what advice they would give other patients. Some of those comments were placed in the form of a survey. At this year's conference, Dr. Reid will present the results of this
survey. If you are interested in participating click here.
Again, our deepest appreciation goes out for all the patients and health care providers that have filled out surveys, submitted their personal stories into our Chronicles, and the exchange of information posted on the message boards. Lymphedema awareness and education is slowly gaining. When our efforts are combined, this enables a continued mutual goal of raising awareness, gaining education and sharing knowledge.