Background Few patients referred for head, neck and facial lymphoedema as widely viewed that very little could be done, apart from prescribing tight fitting compression garments which are very constrictive and have a low patient compliance.

Aim

• Improve access for patients experiencing lymphoedema to the head, neck and face.

• Identify alternative treatment methods

• Develop closer working relationships with the Speech and Language, Dietician and Head and Neck services.

Approach Used Four cornerstones of care used:-

• Skin care: application of regular skin cream to hydrate skin, prevent infection and encourage self-management

• Manual Lymphatic Drainage (MLD): specialised gentle massage to aid and stimulate drainage.

• Simple Lymphatic Drainage; patient learns to move the build-up of fluid

• Exercises (facial):- Encourages muscle movement, aids movement of lymphatic fluid. Breathing exercises stimulate deeper lymphatic vessels in chest and abdomen to enhance lymph drainage.

• Compression worn to maintain shape, reduce swelling.

New treatment modalities (accompanied by modified MLD):

• Low level laser therapy: infra-red wavelength penetrates deep into tissues, aids softening of fibrosis and scar tissue, useful in treating cording.

• Deep oscillation therapy: - penetrates deep into body tissue triggering lasting resonance

• Kinesio Tape: increases body’s ability to drain lymphatic drainage to healthy lymph nodes

These innovative treatments have proved to be an effective adjunct to our existing specialist knowledge and enhanced treatments offered to patients

Measurements pre and post treatment compared using photographs

Patients complete questionnaire after each session, record any immediate changes to symptoms.

Outcomes Increased referrals for treatment to head, neck and face

2011/2012 - 5 referrals

2012/2013 – 17 referrals

Development of a closer working relationship with the surgical head and neck multidisciplinary team at hospital.

Patient comments I don’t feel that everyone is looking at my face as they did before, I felt like I was the elephant man, much happier and I went for a walk with the wife, I wouldn’t have done that a few weeks ago.

I was able to eat normal food after treatment for that day