Treatment of lymphatic disease is complicated and controversial, due in part to the limited understanding of the
lymphatic system. Lymphedema (LE) is a frequent complication after surgical resection and radiation treatment in
cancer survivors, and is especially debilitating in regions where treatment options are limited. Although some extremity
LE can be effectively treated with manual lymphatic drainage (MLD) therapy or compression devices to direct proximal
lymph transport, head and neck LE is more challenging, due to complicated geometry and complex lymphatic structure
in head and neck region.
Herein, we describe the compassionate use of an investigatory technique of near-infrared (NIR) fluorescence imaging to
understand the lymphatic anatomy and function, and to help direct MLD in a patient with head and neck LE.
Immediately after 9 intradermal injections of 25 μg indocyanine green each around the face and neck region, NIR
fluorescence images were collected using a custom-built imaging system with diffused excitation light illumination.
These images were then used to direct MLD therapy. In addition, 3-dimensional (3D) surface profilometry was used to
monitor response to therapy.
NIR fluorescence images of functioning lymphatic vessels and abnormal structures were obtained. Precise geometries of
facial structures were obtained using 3D profilometry, and detection of small changes in edema between therapy sessions
NIR fluorescence imaging provides a mapping of lymphatic architecture to direct MLD therapy and thus improve
treatment efficacy in the head and neck LE, while 3D profilometry allowed longitudinal assessment of edema to evaluate
the efficacy of therapy.