Surgical management of secondary facial lymphedema after oncological treatment

Lymphatic insufficiency in extremities has been extensively dealt with.1,2 In contrast, chronic facial lymphedema is an uncommon disease. There are few published articles in the literature reviewed concerning the management of isolated facial lymphedema.1–3 The etiology could be a primary disease, whether dermatological and inflammatory, infectious or congenital (Morbihan disease, nephrotic syndrome, Hennekam syndrome, Melkersson–Rosenthal syndrome).1,2,4–7 On the other hand, it can be secondary to treatment for head and neck tumors (ablative surgery, neck dissection and locoregional radiotherapy (RT)).1,2,5 The etiology and pathogenesis consist of lymphatic blockage by scar tissue, trauma or repeated episodes of infection and inflammation.2 It is usually transitory because the flow is diverted to the collateral vessels. If the collateral flow is seen to be compromised, the inflammation may be progressive and require emergency treatment.2 It causes functional alterations (difficulty in swallowing and speaking) and visible disfigurement, and the patient has to cope with the psychological impact caused by the deformity and social isolation.1 The therapeutic options are pharmacological (diuretics, benzopyrones and flavonoids), rehabilitative (drainage and compression1) and surgical (local excision, liposuction, dermolipectomy, autologous lymph vessel transplantation, lymphaticovenous anastomosis and microsurgical flaps).1,5,8 We present a case of successful drainage of an unremitting facial lymphedema via the dermal lymphatic vessels of a deltopectoral flap.