QJM Advance Access originally published online on February 20, 2008
QJM 2008 101(4):325-326; doi:10.1093/qjmed/hcn015
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Godoy & Godoy technique of cervical stimulation in the reduction of edema of the face after cancer treatment
São José do Rio Preto, Brazil.
email: godoyjmp{at}riopreto.com.br
The estimated number of cases of cancer of the lips and mouth in Brazil in 2007 was 10 380 among men and 3780 among women.1 Of the cancers of lips and mouth (buccal mucous membranes, gum, hard palate, tongue and mouth floor), lip cancer is the most common in Caucasians.1 Cancer of the other regions of the mouth mainly affect over 40-year-old men, in whom the risk increases with smoking, alcohol ingestion, bad buccal hygiene and inappropriate use of dental prosthesis.2 The symptoms include the appearance of superficial ulcers, white or red blotches in the buccal mucous membrane, or even cervical lymphadenomegalia.2 Surgery, radiotherapy and chemotherapy, either alone or combined are the applicable therapeutic methods for cancer of the mouth.
Complications of the surgical and radiotherapeutic treatment include edema, reduction in the flow of saliva and fibrosis.3,4 However, the conventional treatment options of these complications are not always efficacious. The objective of the current study is to report the use of a form of cervical stimulation developed by Godoy & Godoy to reduce lymphedema of the head and neck.
A 52-years-old male patient was consulted in our service with complaints of pain and edema of the face and neck. The subject reported a neoplasia of the mouth 2 years earlier, which was treated by surgery, chemotherapy and radiotherapy. Eight months prior to this report the patient underwent tracheostomy due to edema of the face. He was also taking analgesics on a daily basis to alleviate the pain. Manual lymph drainage was indicated but was unsuccessful. Even with the drainage, the symptoms worsened, which led the patient to look for another option of treatment when he was referred to our service. At physical examination of the head and neck, the patient had generalized edema of the face and tongue, was fed through a nasogastric tube and had been submitted to tracheotomy, as is illustrated in Figure 1. The cervical stimulation technique developed by Godoy & Godoy was indicated. The technique was performed for 20 min on Wednesday, Thursday and Friday totaling 60 min of treatment. On Monday, there was already evidence of improvement as illustrated in Figure 2.
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The study received the approval of the Local Ethics Research Committee of University Medical of São Jose do Rio Preto-Brazil and patient and her responsible familiar has informed of study and given written consent.
The present report describes a simple conduct that can change the quality of life and reduce complications after the treatment of head and neck cancer. Note in this case, visual limitations, where edema impeded the patient from seeing and caused pain and general discomfort, which improved after treatment. The initial technique of manual lymph drainage employed did not provide positive effects and was accompanied by deterioration of the edema and thus another approach was necessary. The cervical stimulation technique developed by Godoy & Godoy reduced the edema both of the face and of the extremities (study awaiting publication).4 It is believed that a functional mechanism of this technique may interfere in the contractions of lymphangions. Significant reductions are observed over a short period of time as in this case, in diverse situations such as edema after trauma or surgery or even for lymphedema itself. Studies have shown that chronic stages, including even the most advanced with limitations in the joint mobility, may benefit with this treatment.4
It is important that drainage techiniques are not confused with massage, thus, the reproducibility of results depends on trained professionals who understand the method. Surgeries of the face and neck frequently course with edema and this approach may allow, in a short period of time, a limitation of this complication. Other considerations is association between cellulitis and erysipelas with lymphoedema.5
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1. INCA. Estimativa de câncer para cavidade oral em 2007. (2007) www.inca.gov.br/estimativa/.
2. Wünsch Filho V. The epidemiology of oral and pharyngeal cancer in Brazil. Oral Oncol (2002) 38:737–46.[CrossRef][Web of Science][Medline]
3. Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA. Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg (1998) 118:616–24.[CrossRef][Web of Science][Medline]
4. Godoy JMP, Godoy MFG, Braile DM. Drenagem Linfática e Qualidade de Vida em Paciente com Laringectomia. Ver Port ORL (2000) 38:47–9.
5. Godoy JMP, Silva HS. Prevalence of cellulitis and erysipelas in post-mastectomy patients after breast cancer. Arch Med Sci (2007) 3:249–51.
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