Disclosures: Benjamin Miller, DO: Nothing to disclose

Case Description: This is a 62-year-old woman with oropharyngeal SCC complicated by severe radiation fibrosis and facial lymphedema after radiation, restricting her cervical range of motion. She was initially treated by physical therapy with aggressive stretching and manual therapy, compression garments, and intermittent pneumatic compression to improve her lymphedema. Right-sided facial edema improved with these techniques but left-sided lymphedema remained. She was referred to plastic surgery for indocyanine green (ICG) lymphangiography for further evaluation.

Setting: Cancer rehabilitation and plastic surgery outpatient clinics.

Patient: A 62-year-old woman with radiation fibrosis, cervical dystonia, and facial lymphedema after radiation for oropharyngeal squamous cell carcinoma (SCC).

Assessment/Results: Left-sided ICG lymphangiography showed two vessels; one small vessel towards the medial canthus, and one large vessel towards the anterior pretragus with dermal back flow. These vessels were deemed candidates for lymphovenous anastomosis, which is pending.

Discussion: Lymphedema and other sequelae of radiation and oncologic treatment in cancer patients can lead to significant morbidity and decrease in quality of life. Interdisciplinary management including physical therapy, plastic surgery, oncology, and physiatry can prove invaluable to successful treatment in patients with lymphedema after cancer treatment.

Conclusion: Using an interdisciplinary approach, lymphedema refractory to conservative therapy can be successfully treated. ICG lymphangiography can help identify vessels to be targeted to help improve lymphedema in conjunction with standard therapy.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/interdisciplinary-management-of-facial-lymphedema-evaluated-by-indocyanine-green-lymphangiography-a-case-report/