Head drop syndrome secondary to multimodality treatments for head and neck cancer

Abstract

Five patients under follow-up for head and neck squamous cell carcinoma (SCC) at Southern General Hospital Glasgow presented with a fixed flexion deformity of the neck. These cases are characterized by the onset of severe weakness and atrophy of the neck extensor muscles and anterior fibrosis forcing the mandible to the chest wall. This causes considerable morbidity with communication, feeding, and appearance. This is a rare complication with no curative treatments that has not been reported previously by a UK center and is likely to become important with the increased use of multimodality treatments for head and neck SCC.

The Role of the Headmaster Collar (Cervical) for Dropped Head Syndrome in Hodgkin Lymphoma Survivors

“…However, despite differences in design, the present study participants using the Headmaster Collar also described issues with discomfort, specifically regarding the bony prominences that can become accentuated with radiation‐induced myogenic injury and atrophy . Despite the increased pressure load on the chin with the Headmaster Collar, none of the participants developed secondary pressure sores as reported previously with other collars …”

“…11 Despite the increased pressure load on the chin with the Headmaster Collar, none of the participants developed secondary pressure sores as reported previously with other collars. 12 To address concerns of undue pressure on the chin and the restrictions of range of motion associated with the Headmaster Collar, an alternative brace to consider could be the baseball cap orthosis as described previously by a small case study of two patients, 13 or the head-up orthotic described in a case study of a single patient. 14 However, there are limited data available regarding the different brace designs for DHS.…”

“…Conservative management can range from therapy, hard collars, or steroid injections. 15 Physical therapy has been shown to be helpful in maintaining neck strength and preventing deterioration, 16 although radiation-induced DHS presents a clinical challenge because of its progressive nature. Macé et al described a physical therapy program consisting of cervical traction with an exercise program focused on cervical proprioception and neuromuscular strengthening.…”

Early-onset dropped head syndrome after radiotherapy for head and neck cancer: dose constraints for neck extensor muscles

“…We consider that the early-onset DHS differs from late-onset DHS. Recently, early-onset DHS has been reported (Case 4–9 in Table 3 ) [ 7 , 8 ]. In contrast to the findings of our study, neck extensor muscle atrophy was observed in the reported cases of early-onset DHS.…”

“…This syndrome has been reported as a late-onset complication following radiotherapy [ 6 ]. Recently, a few case reports have been published about early-onset DHS after multimodality treatment for head and neck carcinoma [ 7 , 8 ]. We have had experience of three patients with early-onset DHS.…”