A New Indocyanine Green Lymphography Protocol for Assessment of Lymphedema in the Head and Neck

Head and neck cancer and its treatment may result in lymphedema, however, no specific imaging criteria have been assigned to diagnose this condition. This study reports an ICG lymphography protocol for investigating changes in individuals experiencing swelling post-neck dissection. ICG lymphography was performed in 10 healthy participants and 16 individuals who complained of facial or neck swelling following treatment for head and neck cancer. Four ICG injection sites were proposed to demonstrate 3 lymphatic territories draininig to upper cervical, submandibular, and submental nodes. In healthy controls, 3 lymphatic drainage pathways were demonstrated in the ipsilateral neck. In individuals post-neck dissection, dermal backflow was present and 2 additional drainage pathways were visualized to the paraspinal and axillary regions. This study proposes an anatomy-based protocol for ICG lymphography and interpretations of imaging findings in patients post-neck dissection surgery. ICG lymphography offers a diagnostic imaging tool for head and neck lymphedema.