Prolonged facial edema is an indicator of poor prognosis in patients with head and neck squamous cell carcinoma

Objective: The purpose of this study was to identify the causes of prolonged facial edema and its associations with other clinical factors. Summary background data: Facial edema sometimes is observed in patients with head and neck squamous cell carcinoma (HNSCC), but its prevalence and association with other factors is unclear. Methods: Between July 2003 and July 2007, the medical records from 264 patients with HNSCC were reviewed. Prolonged facial edema is defined as persistence of edematous status (largest thickness >5 mm by CT scan) for more than 100 days. Clinical data including age, gender, tumor stage, and tumor primary sites were recorded. Statistical analyses were performed to determine the prognostic effect of prolonged facial edema, as well as its relationship to other clinical variables. The etiology of prolonged facial edema was also analyzed. Results: Prolonged facial edema occurred in 32 (12.1%) patients. The etiologies included internal jugular vein thrombosis, local infection, neck lymph nodes dissection, flap reconstruction, and direct vessel compression by tumors or metastatic lymph nodes. There was no significant difference in the incidence of prolonged facial edema in patients receiving different treatment modalities; however, patients receiving neck dissection correlated with the occurrence of late-onset facial edema. In addition to previously demonstrated prognostic factors (T status, nodal involvement and distant metastasis), prolonged facial edema was also identified as independent prognostic indicators for HNSCC patients (P=0.001). Conclusions: Prolonged facial edema may reflect the underlying disease status, and it can be applied as a prognostic marker in patients with HNSCC.