The lymphatic system must have variation in tissue pressure to load it and to help flow. Being a low pressure system, external pressure must not be constantly high on any segment and there must be a pressure gradient along it. When the flow rate of lymph fails there can be compromised immunity, a tendency to deposit fat, fibrotic induration, and a vicious cycle of worsening of cellular and organ health often associated with recurrent infection.

As we age we become less active, lose muscle tone, and increase our weight, develop a higher percentage of body fat, and may have poor skin care and be prescribed medications which impact on lymphatic load. Combined with this, the tendency to immobility, limb dependency and periods of time when high external pressures exist in small superficial areas increase the risk of or contribute to lymphoedema through reducing lymphatic flow. Older people are more likely to have had more radical surgery and radiotherapy for cancer with more significant damage to their lymphatic systems, again adding to lymphoedema risk. Immobility, hypertension, venous disease, kidney and liver failure can lead to oedema, while thyroid dysfunction can cause myxedema, and genetic or metabolic issues can cause lipoedema, compounding the clinical problems.

A key point in good management is early identification and accurate diagnosis. Ideally, other issues that especially impact on lymphatic load should be managed prior to targeted and sequenced treatment for the swelling, with the aim being to improve patient comfort. Management can involve the patient, partner, family or carer as well as a range of health professionals to help reduce or maintain limb size, appearance and function as well as reduce symptoms of heaviness, tension and discomfort and a range of other issues that impact on quality of life and activities of living.

Lymphoedema is a chronic condition that leads to reduced quality of life through its negative impacts on physical, psychological, and social aspects of health. Limb swelling leads to discomfort and pain, reduced movement and function, and acute inflammatory episodes. Individuals experience altered body image and self-esteem impacting on social interaction. There is evidence that specialist management of the condition leads to improved quality of life. Concern regarding the adequacy of lymphoedema services led to the commissioning of a needs assessment by the Core Cancer Review Group in Fife, Scotland. The needs assessment used a variety of methods. Current services were located through consultation of known providers and databases. Existing databases were analysed to find out the number of people requiring the service: hospital admissions and diagnoses were analysed alongside a survey of primary practices in Fife. Access to existing services was explored through a telephone survey of referrers (n = 44), and qualitative interviews with five service providers and five clients. At the time of the study, non-palliative National Health Service (NHS) provision consisted of one part-time clinician; the service provided was under pressure from rapidly increasing referrals. However, consensus from referrers, providers, and clients indicated that there were obstacles to achieving diagnosis and referral, especially for those with non-cancer-related lymphoedema. This was primarily due to poor referrer awareness of the condition, its management, and existing services, for example, only seven per cent of those surveyed would refer to existing specialist services. Delayed referral is a significant issue, as prompt intervention leads to more positive treatment outcomes. As a result of the needs assessment, recommendations were made to increase staffing levels, promote awareness of the condition and related services, and improve geographical and multidisciplinary coordination of the service.

We report a case of sensory deprivation that occurred as a consequence of progressive head and neck lymphoedema, following combined surgery and radiotherapy for squamous cell carcinoma. The management of head and neck lymphoedema is discussed and measures are suggested for improving the sensory deprivation experienced by the worst affected patients.