Recommendations for head and neck surgical procedures during the COVID-19 pandemic

Abstract

The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread exponentially worldwide. In Brazil, the number of infected people diagnosed has been increasing and, as in other countries, it has been associated with a high risk of contamination in healthcare teams. For healthcare professionals, the full use of personal protective equipment (PPE) is mandatory, such as wearing surgical or filtering facepiece class 2 (FFP2) masks, waterproof aprons, gloves, and goggles, in addition to training in care processes. A reduction in the number of face-to-face visits and non-essential elective procedures is also recommended. However, surgery should not be postponed in the case of the most essential elective indications (mostly associated with head and neck cancers). As malignant tumors of the head and neck are clinically time sensitive, neither consultations for these tumors nor their treatment should be postponed. Postponing surgical treatment can result in a change in the disease stage and alter an individual's chance of survival. In this situation, planning of all treatments must begin with the request for, in addition to routine examinations, a nasal swab polymerase chain reaction for SARS-CoV-2 and chest computed tomography. Only if the results of these tests are positive or if fever or other symptoms suggestive of COVID-19 are present should the surgical procedure be postponed until the patient completely recovers. This is mandatory not only because of the risk of contamination of the surgical team but also because of the increased risk of postoperative complications and high risk of death. During this pandemic, the most effective safety measures are social distancing for the general public and the adequate availability and use of PPE in the healthcare field. The treatment of other chronic diseases, such as cancer, should be continued, as the damming of cases of these diseases will have a deleterious effect on the public healthcare system.

Impact of the COVID-19 pandemic in the head and neck cancer treatment in the Brazil

“…Head and neck surgeons present a high risk of COVID-19 contamination because of intimate contact with nasal, oral and oropharynx mucosa [11] . Thereby, during the peak of the pandemic the World Health Organization (WHO) ratified by most medical societies has taken steps to reduce the risk of contagion by the population and health professionals, leading to the created several protocols [12] with main focus in severe cases, emergencies and canceling elective surgical procedures [13] . Thus, we evaluated preliminary the impact of the COVID-19 pandemic in HNC treatment, comparing the number of surgeries and radiotherapy and chemotherapy procedures performed during the pre-pandemic and pandemic periods in the Brazil.…”

The Impact of the COVID-19 Pandemic on Head and Neck Surgery Training: A Brazilian National Survey

“…The note issued rules regarding working hours, maximum of hours outside of the specific area of training, and development of educational activities, with the intent of assuring that all residents had minimum training in their fields while assisting with the health crisis. 11 Unfortunately, not all residency programs followed this recommendation.…”

Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic

“… The use of an electric or ultrasonic scalpel can promote aerosol formation, and therefore, should be avoided. When necessary, they should be simultaneously used with a vacuum coupled to a HEPA filter system 61 . Local-regional anesthesia should be preferred whenever possible, as it reduces the number of AGPs (i.e., intubation and extubation of the patient) 62 .…”

“…The use of an electric or ultrasonic scalpel can promote aerosol formation, and therefore, should be avoided. When necessary, they should be simultaneously used with a vacuum coupled to a HEPA filter system 61 .…”