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1.
Head Neck ; 42(7): 1507-1515, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-614117

ABSTRACT

INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Head and Neck Neoplasms/therapy , Infection Control/standards , Medical Oncology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Ambulatory Care/standards , COVID-19 , Combined Modality Therapy , Continuity of Patient Care/standards , Coronavirus Infections/diagnosis , Head and Neck Neoplasms/diagnosis , Humans , Multi-Institutional Systems , Otorhinolaryngologic Surgical Procedures/standards , Palliative Care/standards , Patient Safety , Pennsylvania , Personal Protective Equipment , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Terminal Care/standards , Tertiary Care Centers
2.
Head Neck ; 42(7): 1497-1502, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-264234

ABSTRACT

AIM: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for health care practitioners and facilities serving at the frontlines of this pandemic. With regard to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. METHODS: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment vs telehealth assessment during the COVID-19 pandemic. RESULTS: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients. CONCLUSIONS: The COVID-19 pandemic has required health care practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high risk for severe COVID-19 illness are also higher risk for the development of OPMDs.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Infection Control/methods , Mouth Neoplasms/diagnosis , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Assessment , Administration, Topical , Anti-Infective Agents, Local/administration & dosage , COVID-19 , Clinical Decision-Making , Coronavirus Infections/transmission , Critical Pathways , Diagnosis, Differential , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Leukoplakia, Oral , Personal Protective Equipment , Pneumonia, Viral/transmission , Povidone-Iodine/administration & dosage , SARS-CoV-2 , Telemedicine
3.
Head Neck ; 42(6): 1273-1277, 2020 06.
Article in English | MEDLINE | ID: covidwho-143443

ABSTRACT

BACKGROUND: This case highlights challenges in the assessment and management of the "difficult airway" patient in the SARS-CoV-2 (COVID-19) pandemic era. METHODS: A 60-year-old male with history of recent transoral robotic surgery resection, free flap reconstruction, and tracheostomy for p16+ squamous cell carcinoma presented with stridor and dyspnea 1 month after decannulation. Careful planning by a multidisciplinary team allowed for appropriate staffing and personal protective equipment, preparations for emergency airway management, evaluation via nasopharyngolaryngoscopy, and COVID testing. The patient was found to be COVID negative and underwent imaging which revealed new pulmonary nodules and a tracheal lesion. RESULTS: The patient was safely transorally intubated in the operating room. The tracheal lesion was removed endoscopically and tracheostomy was avoided. CONCLUSIONS: This case highlights the importance of careful and collaborative decision making for the management of head and neck cancer and other "difficult airway" patients during the COVID-19 epidemic.


Subject(s)
Betacoronavirus , Carcinoma, Squamous Cell/surgery , Coronavirus Infections/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Tonsillar Neoplasms/pathology , Tracheal Neoplasms/surgery , COVID-19 , COVID-19 Testing , Carcinoma, Squamous Cell/secondary , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Humans , Male , Middle Aged , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , SARS-CoV-2 , Tracheal Neoplasms/secondary
4.
Head Neck ; 42(6): 1268-1272, 2020 06.
Article in English | MEDLINE | ID: covidwho-116903

ABSTRACT

AIM: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has put health care workers at risk when exposed to aerosolized viral particles during upper airway mucosal surgery. The objective of this review was to discuss topical preparations that could be utilized preoperatively to help to decrease viral load and potentially reduce the risks of viral transmission. METHODS: A PubMed/MEDLINE database review of articles was performed querying topical preparations with virucidal activity against coronaviruses. RESULTS: Povidone-iodine (PVP-I) solutions ranging from 0.23% to 7% have been found to demonstrate highly effective virucidal activity against a broad range of viruses including several coronaviruses responsible for recent epidemics including SARS-CoV-1 and MERS-CoV. CONCLUSIONS: While specific evidence regarding SARS-CoV-2 is lacking, PVP-I-based preparations have been successfully demonstrated to reduce viral loads of coronaviruses. They are relatively safe to use in the upper airway and may reduce risk of SARS-CoV-2 aerosolization during upper airway mucosal surgery.


Subject(s)
Anti-Infective Agents, Local/therapeutic use , Betacoronavirus , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Otolaryngology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Administration, Topical , Aerosols , COVID-19 , Humans , Mucous Membrane/surgery , SARS-CoV-2
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