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 student 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 difficult 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
Dr. Reid's Corner
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