Physiotherapeutic Intervention on Internal Lymphedema Post-Treatment of HPV-Positive Tonsillar Carcinoma: Case Report

Introduction:  Internal lymphedema is a frequent and underdiagnosed complication after treatment of oropharyngeal squamous cell carcinoma (SCC), particularly in HPV-positive cases. The lack of specific protocols hinders early detection and proper management. This study aims to report the physiotherapeutic intervention in a patient with bilateral internal lymphedema resulting from the treatment of HPV-positive tonsillar SCC.

Case report:  A 49-year-old male patient underwent bilateral surgery and radiotherapy, developing internal lymphedema with significant obstructive and dysphagic symptoms. The physiotherapeutic approach included manual lymphatic drainage, therapeutic exercises, intra- and extraoral photobiomodulation, shockwave therapy, and cervical fibrosis release. A custom-made flat compression garment was also applied to the cervicofacial region. Subjective and functional improvements were observed, allowing the patient to complete radiotherapy without interruption.

Conclusion:  The integrated physiotherapeutic intervention was effective in reducing internal lymphedema symptoms in a patient with oropharyngeal cancer. This case highlights the importance of early detection and the need for specific therapeutic strategies based on lymphatic physiology.

Key words:
Lymphedema/complications; Physical Therapy Services; Head and Neck Neoplasms/surgery; Human Papillomavirus Viruses; Rehabilitation