Head and neck swelling

Introduction – The lymphatic system

In order to understand lymphoedema you need to know a little bit about the lymphatic system.

The lymphatic system is a network of vessels (tubes) and nodes (glands) that cover the body and drain fluid from the tissues into the blood stream. The lymph vessels collect extra fluid, protein and waste material from the body tissues and transport it through the lymph nodes back into the blood. The lymph nodes filter the fluid of any unwanted material and make special cells that help the body fight infection.

How is lymphoedema managed?

We manage lymphoedema in a structured way. Below are listed the 4 key elements to the treatment we recommend. Although lymphoedema cannot be cured, it can be managed by a combination of these essential elements.

Skin care (see advice)

To reduce the risk of making the swelling worse, take special care not to injure your skin or introduce infection.

Exercise

Gentle exercise will activate the muscles which help pump lymph fluid out of your head and neck areas.

Simple Lymph Drainage

Simple lymph drainage is used to stimulate the drainage of lymph in the lymph vessels to other parts of the body.

Hosiery

If appropriate, wearing a specially designed garment will reduce the collection of lymph fluid in your head and neck and assist your muscles to pump it away.

Taking care of your skin

Good skin care plays a vital part in the treatment of the swollen areas on your head or neck. Stretched skin can become dry and cracked and any break or injury to the skin is a potential entry for bacteria which thrive in the warm, protein-rich fluid of the swelling.

Prevention of infection in the skin tissues is of great importance. Not only is an infection unpleasant and painful, but it may also cause the swelling to get worse. Any infection should be treated promptly with a two week course of antibiotics. So if you think you may be developing an infection see your doctor immediately. If you do have an infection, discontinue the use of any compression garments and stop massage or exercise until it is better.

Some people who suffer repeated infections may be prescribed a small but continuous dose of antibiotics over a long period of time as a preventative treatment. If infection tends to be a problem, it may be advisable to take an emergency supply of antibiotics with you, especially if you are going on holiday, just in case they are needed. Your doctor will advise you.

You may hear the term acute inflammatory episode (AIE) or cellulitis. These are commonly used words which refer to an infection of the skin tissues.

Mouth care

• Pay close attention to oral hygeine, regularly clean your teeth especially after food and visit your dentist every 6 months
• Floss your teeth if you are able to
• Use a gentle mouthwash, check with your doctor for the best treatment for you
• Apply lip balm to your lips to keep them hydrated
• Treat mouth ulcers, check with your doctor for the best treatment for you
• Inform your dentist of your diagnosis and treatment plan.

Exercises

• Exercise is important for helping to drain lymph fluid away since muscles help to pump the lymph out of the affected Very vigorous exercise however, causes an increased blood supply, consequently forming more fluids in the tissues
• Try to do gentle, regular exercise rather than intensive bursts, at least twice a day
• Do the exercises slowly, rhythmically and gently
• The muscles in your face and neck can play a vital role in helping to drain fluid away
• Exaggerated facial expressions are an easy way in which to do this as well as poking out your tongue.

Other exercises to help with head and neck movement

• Move your head from side to side attempting to look over your shoulder
• Move your head up and down, gently bringing your head up and gently stretching it backwards
• Move your head slowly around in circles
• Shrug your shoulders up and down
• Shrug your shoulders forwards and backwards
• Move your tongue (if able) around the gums on the inside and outside of your teeth. From the very back to the front
• Massage the inside of your mouth with your tongue
• Chewing is also a very easy way in which to help with Chewing on sugar free chewing gum if you are able to can help
• Facial swelling can be worse in the morning following sleep, so propping the bed up at the head end will encourage the drainage of fluid.

Lymphoedema taping

Your specialist nurse may decide to apply lymphoedema tape to your face. An example is illustrated below:

As the face, head and neck moves throughout the day, the tape that has been applied to the skin will gently massage the tiny lymphatics which are just below the surface of the skin. This will encourage them to drain the fluid away from the swelling.

You will be given a diagram of how your own lymphoedema taping is applied. This can be attached to this page, if necessary.

Simple lymph drainage for head and neck

Simple Lymph Drainage massage (SLD) is a special form of massage used to help people with Lymphoedema and is based on the principles of manual Lymphatic Drainage. The aim of SLD is to move lymph fluid to other areas of the body where it can drain away more easily.

• The massage should be very gentle and light, just enough pressure to move the skin and should not cause any redness
• The massage should be slow and rhythmical with your hand relaxed
• You should spend about 15-20 minutes doing the massage, twice a day
• The massage should be done on bare skin, not over clothes and do not use any oils or creams
• Make sure you are in a comfortable position, and in a quiet place where you won’t be disturbed
• It is fine for someone else to help you with the massage if you wish

Please bring this booklet with you. Your nurse specialist will tailor the SLD to suit your swelling, giving you precise directions and diagrams to follow.

You will be given diagrams which show your own prescription for Simple Lymphatic Drainage which can be attached to this page at your appointment.