Surgical Management of Head and Neck Lymphedema: A Scoping Review

Introduction: Head and neck lymphedema (HNL) is a debilitating sequela of head and neck cancer (HNC) treatment associated with functional impairment, cosmetic deformity, and reduced quality of life (QOL). Surgical management is increasingly used for refractory disease, yet treatment strategies and outcome assessment remain variable.

Methods: A scoping review following PRISMA-ScR guidelines was performed in July 2025 using PubMed, Embase, Scopus, and CINAHL databases. Eligible studies included adult patients who underwent surgical intervention for HNL following HNC treatment. Data extracted included patient characteristics, lymphedema staging methods, surgical techniques, outcome measures, and complications.

Results: Fourteen studies encompassing 54 patients met inclusion criteria. Most patients developed external HNL (91%) following neck dissection with or without radiation. The neck was the most commonly involved site, followed by the face and periorbital region. Median time from cancer treatment to HNL surgery was 17 months (range 3–84). Surgical interventions fell into three main categories: lymphatic reconstruction (n=18), volume-reduction procedures (n=31), and contour restoration (n=5). Outcome assessment varied across studies, including clinical grading, quantitative measurements, and patient-reported outcome measures. Lymphatic procedures demonstrated objective reductions in edema, while excisional techniques improved appearance-related QOL. Overall complication rates were low.

Conclusions: Surgical options for HNL are diverse and show promising functional and cosmetic outcomes. Standardized staging systems and prospective studies are needed to guide patient selection and optimize surgical decision-making.