Alternative Diagnostic Methods for Post-operative Lymphatic Fistula in Head and Neck Surgeries - A Narrative Review

A rare but potentially life-threatening complication of head and neck procedures is post-operative lymphatic fistula. While conventional diagnosis relies on clinical signs, simple biochemical tests, and imaging, these methods have limitations. This narrative review provides an overview of emerging alternative diagnostic techniques for post-operative lymphatic fistulas in head and neck surgeries.

A comprehensive search of PubMed, Embase, Scopus, and Web of Science databases was performed, and all prospective and retrospective studies, case series with, and randomized controlled trials that reported the new diagnosis, methods or radiographic presentation, and management of post-operative chylous leaks in head and neck surgeries were included. The quality of articles assessed using SANRA criteria.

The alternative modalities identified include lymphangiography/lymphoscintigraphy, near-infrared imaging, ultrasound approaches, cross-sectional imaging, biosensors, and lymphatic biomarkers. Each of these techniques offers distinct advantages in terms of anatomical visualization, functional assessment, safety, point-of-care use, cost, availability, and treatment guidance. Nevertheless, they also possess specific limitations that must be considered.

The choice of diagnostic methods should be individualized based on the clinical context, resources, and expertise available. Further research is necessary to refine these novel techniques and establish their role in clinical practice. To translate these innovations into improved patient care, it is essential for clinicians, radiologists, and biomedical engineers to collaborate closely. Therefore, a comprehensive understanding of post-operative lymphatic fistulas and the emerging diagnostic options is imperative for head and neck surgeons to effectively manage this challenging complication.