Beyond Swelling: Redefining Head and Neck Lymphedema through Surveillance and Prevention

Head and neck lymphedema (HNL) is a common early and late effect of head and neck cancer treatment that can involve both external tissues and internal pharyngeal and laryngeal structures, yet is frequently under-recognized. This review summarizes contemporary evidence on epidemiology, mechanisms, assessment, functional impact, management, and prevention-oriented surveillance. When systematically assessed, particularly with routine endoscopy, HNL is identified in the majority of survivors (approximately 70% to > 90%, depending on methods), and severity correlates with dysphagia, voice impairment, airway symptoms, and reduced quality of life. Complete decongestive therapy remains first-line management and improves external edema in many patients, while emerging modalities (advanced pneumatic compression, photobiomodulation, and microsurgical reconstruction) show early promise but require higher-quality evaluation. Integrating systematic assessment and timely rehabilitation intosurvivorship care may improve functional outcomes, while acknowledgingongoing evidence gaps.