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1.
J Laryngol Otol ; 135(11): 1025-1030, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1569188

ABSTRACT

OBJECTIVE: Patients with coronavirus disease vaccine associated lymphadenopathy are increasingly being referred to healthcare services. This work is the first to report on the incidence, clinical course and imaging features of coronavirus disease vaccine associated cervical lymphadenopathy, with special emphasis on the implications for head and neck cancer services. METHODS: This was a retrospective cohort study of all patients referred to our head and neck cancer clinics between 16 December 2020 and 12 March 2021. The main outcomes measured were the proportion of patients with vaccine-associated cervical lymphadenopathy, and the clinical and imaging characteristics. RESULTS: The incidence of vaccine-associated cervical lymphadenopathy referrals was 14.8 per cent (n = 13). Five patients (38.5 per cent) had abnormal-looking enlarged and rounded nodes with increased vascularity. Only seven patients (53.9 per cent) reported full resolution within an average of 3.1 ± 2.3 weeks. CONCLUSION: Coronavirus disease vaccine associated cervical lymphadenopathy can mimic malignant lymphadenopathy and therefore might prove challenging to diagnose and manage correctly. Healthcare services may encounter a significant increase in referrals.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Head and Neck Neoplasms/immunology , Lymphadenopathy/chemically induced , Lymphadenopathy/epidemiology , Adult , Aged , Aged, 80 and over , Female , Head and Neck Neoplasms/virology , Humans , Incidence , Male , Middle Aged , Neck/pathology , Neck/virology , Retrospective Studies , SARS-CoV-2
2.
Br J Radiol ; 95(1129): 20210570, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1566544

ABSTRACT

OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) is seen as a serious delayed complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to describe the most common imaging features of MIS-C associated with SARS-CoV-2. METHODS: A retrospective review was made of the medical records and radiological imaging studies of 47 children (26 male, 21 female) in the age range of 25 months-15 years who were diagnosed with MIS-C between August 2020 and March 2021. Chest radiographs were available for all 47 patients, thorax ultrasound for 6, chest CT for 4, abdominal ultrasound for 42, abdomen CT for 9, neck ultrasound for 4, neck CT for 2, brain CT for 1, and brain MRI for 3. RESULTS: The most common finding on chest radiographs was perihilar-peribronchial thickening (46%). The most common findings on abdominal ultrasonography were mesenteric inflammation (42%), and hepatosplenomegaly (38%, 28%). Lymphadenopathy was determined in four patients who underwent neck ultrasound, one of whom had deep neck infection on CT. One patient had restricted diffusion and T2 hyperintensity involving the corpus callosum splenium on brain MRI, and one patient had epididymitis related with MIS-C. CONCLUSION: Pulmonary manifestations are uncommon in MIS-C. In the abdominal imaging, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites and bowel wall thickening are the most common findings. ADVANCES IN KNOWLEDGE: The imaging findings of MIS-C are non-specific and can mimic many other pathologies. Radiologists should be aware that these findings may indicate the correct diagnosis of MIS-C.


Subject(s)
COVID-19/complications , Systemic Inflammatory Response Syndrome/diagnostic imaging , Adolescent , Brain/diagnostic imaging , COVID-19/diagnostic imaging , Child , Child, Preschool , Female , Humans , Magnetic Resonance Imaging , Male , Neck/diagnostic imaging , Neuroimaging , Radiography, Abdominal , Radiography, Thoracic , Retrospective Studies , Tomography, X-Ray Computed , Ultrasonography
3.
BMJ Case Rep ; 14(11)2021 Nov 16.
Article in English | MEDLINE | ID: covidwho-1522935

ABSTRACT

The elderly patient presenting with a neck lump often raises concerns regarding a malignancy. Thyroid gland malignancies are well recognised and subtype characteristics thoroughly researched, whereas rarer types of thyroid carcinoma are reported infrequently and often behave more aggressively. An 83-year-old woman was referred from the general practitioner (GP) to otolaryngology due to a 7-month history of an unexplained enlarging left-sided neck swelling. A fine-needle aspiration revealed cytology consistent with squamous cell carcinoma (SCC). Staging imaging failed to reveal evidence of a primary foci elsewhere. The definitive diagnosis was that of a primary thyroid SCC: a rare entity with limited citations in the literature. Surgical resection has been found to comprise the optimal treatment for this disease. Recognition of the possibility of primary thyroid SCC in elderly patients presenting with a neck lump, with prompt referral to a head and neck specialist permits a timely progression to potentially curative surgical management, a more promising prognosis and reduced mortality rates.


Subject(s)
Carcinoma, Squamous Cell , Thyroid Neoplasms , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/surgery , Female , Humans , Neck/diagnostic imaging , Neck Dissection , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/surgery
4.
Br J Community Nurs ; 26(Sup10): S6-S15, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1431158

ABSTRACT

Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome-percentage tissue water-measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.


Subject(s)
COVID-19 , Lymphedema , Nursing Research , Pandemics , COVID-19/epidemiology , Compression Bandages , Feasibility Studies , Head , Humans , Lymphedema/nursing , Manual Lymphatic Drainage , Neck , Nursing Research/organization & administration , Treatment Outcome , United Kingdom/epidemiology
6.
Pediatr Ann ; 50(7): e276, 2021 07.
Article in English | MEDLINE | ID: covidwho-1311400
7.
J Comput Assist Tomogr ; 45(4): 592-599, 2021.
Article in English | MEDLINE | ID: covidwho-1284963

ABSTRACT

OBJECTIVE: The aim of the study was to aggregate neuroradiological findings in patients with coronavirus disease 2019 (COVID-19) in the brain, head and neck, and spine to identify trends and unique patterns. METHODS: A retrospective review of neuroimaged COVID-19 patients during a 6-week surge in our 8-hospital campus was performed. The brain imaging with reported acute or subacute infarction, intraparenchymal hemorrhage, and all neck examinations were reinterpreted by 2 reviewers. RESULTS: Six hundred seventy-one patients met criteria and were reviewed. Acute or subacute infarction was seen in 39 (6%), intraparenchymal hemorrhage in 14 (2%), corpus callosum involvement in 7, and thalamus in 5 patients. In spine and neck studies, lung opacities and adenopathy were seen in 46 and 4 patients, respectively. CONCLUSIONS: Infarction followed by intraparenchymal hemorrhage was the most common acute findings in the brain with frequent involvement of the corpus callosum and thalami. In the neck, lung abnormalities were frequently present, and adenopathy was almost always associated with a second pathology.


Subject(s)
COVID-19/complications , COVID-19/pathology , Central Nervous System Diseases/complications , Central Nervous System Diseases/diagnostic imaging , Neuroimaging/methods , Adolescent , Adult , Aged , Aged, 80 and over , Brain/diagnostic imaging , Brain/pathology , COVID-19/diagnostic imaging , Central Nervous System Diseases/pathology , Child , Child, Preschool , Female , Head/diagnostic imaging , Head/pathology , Humans , Infant , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neck/diagnostic imaging , Neck/pathology , Pandemics , Retrospective Studies , SARS-CoV-2 , Spine/diagnostic imaging , Spine/pathology , Tomography, X-Ray Computed/methods , Young Adult
9.
BMC Infect Dis ; 21(1): 232, 2021 Feb 27.
Article in English | MEDLINE | ID: covidwho-1105699

ABSTRACT

BACKGROUND: Although there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature. CASE PRESENTATION: We report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. The patient reported COVID-19 symptoms over the previous three weeks. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. All the differential diagnoses were ruled out. Both the anamnestic history of the patient's husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. This was confirmed by nasopharyngeal swab polymerase chain reaction. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was discharged after seven days in good clinical condition and with a negative swab. CONCLUSION: Sudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19.


Subject(s)
COVID-19/complications , Exanthema/etiology , SARS-CoV-2 , COVID-19/diagnostic imaging , COVID-19/drug therapy , Edema/etiology , Female , Humans , Middle Aged , Neck/pathology , Tomography, X-Ray Computed
10.
Lasers Surg Med ; 53(1): 115-118, 2021 01.
Article in English | MEDLINE | ID: covidwho-1060012

ABSTRACT

INTRODUCTION: The COVID-19 pandemic requires us all to re-evaluate aesthetic practices to ensure optimal patient safety during elective procedures. Specifically, energy-based devices and lasers require special consideration, as they may emit plume which has been shown to contain tissue debris and aerosolized biological materials. Prior studies have shown transmission of viruses and bacteria via plume (i.e., HIV and papillomavirus). The purpose of this study was to evaluate plume characteristics of the Er:YAG resurfacing laser (Sciton; Palo Alto, CA) and compare it to the Morpheus8 fractional radiofrequency device (InMode; Lake Forest, CA). METHODS: Five patients who underwent aesthetic resurfacing and/or skin tightening of the face and neck were treated with the Er:YAG (Sciton Joule, Palo Alto, CA) and/or fractional radiofrequency (Morpheus8, Lake Forest, CA) between April 1 and May 11, 2020. Data collected included patient demographics, past medical history, treatment parameters, adverse events, particle counter data, as well as high magnification video equiptment. Patients were evaluated during treatment with a calibrated particle meter (PCE; Jupiter, FL). The particle meter was used at a consistent focal distance (6-12 inches) to sample the surrounding environment during treatment at 2.83 L/min to a counting efficiency of 50% at 0.3 µm and 100% at >0.45 µm. Recordings were obtained with and without a smoke evacuator. RESULTS: Of our cohort (n = 5), average age was 58 years old (STD ±7.2). Average Fitzpatrick type was between 2 and 3. Two patients received Er:YAG fractional resurfacing in addition to fractional radiofrequency during the same treatment session. Two patients had fractional radiofrequency only, and one patient had laser treatment with the Er:YAG only. There were no adverse events recorded. The particle counter demonstrated ambient baseline particles/second (pps) at 8 (STD ±6). During fractional radiofrequency treatment at 1-mm depth, the mean recording was 8 pps (STD ±8). At the more superficial depth of 0.5 mm, recordings showed 10 pps (STD ±6). The Er:YAG laser resurfacing laser had mean readings of 44 pps (STD ±11). When the particle sizes were broken down by size, the fractional radiofrequency device had overall smaller particle sizes with a count of 251 for 0.3 µm (STD ±147) compared with Er:YAG laser with a count of 112 for 0.3 µm (STD ±84). The fractional radiofrequency did not appear to emit particles >5 µm throughout the treatment, however, the Er:YAG laser consistently recorded majority of particles in the range of 5-10 µm. The addition of the smoke evacuator demonstrated a 50% reduction in both particles per second recorded as well as all particle sizes. CONCLUSION: Re-evaluation of the plume effect from aesthetic devices has become important during the COVID-19 pandemic. Further studies are required to characterize viability of COVID-19 viability and transmissibility in plume specimens. Based on this pilot study, we recommend that devices that generate little to no plume such as fractional radiofrequency devices be used in Phase I reopening of practice while devices that generate a visible plume such as Er:YAG laser resurfacing devices be avoided and only used with appropriate personal protective equipment in addition to a smoke evacuator in Phase IV reopening.


Subject(s)
COVID-19/transmission , Cosmetic Techniques/instrumentation , Laser Therapy/instrumentation , Lasers, Solid-State/therapeutic use , Radiofrequency Ablation/instrumentation , Skin Aging/radiation effects , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Cohort Studies , Face , Female , Humans , Male , Middle Aged , Neck , Particle Size , Pilot Projects , Risk Assessment
11.
Diabetes Metab Res Rev ; 37(1): e3354, 2021 01.
Article in English | MEDLINE | ID: covidwho-1059440

ABSTRACT

AIMS: COVID-19 is especially severe for elderly subjects with cardiometabolic and respiratory comorbidities. Neck circumference (NC) has been shown to be strongly related to cardiometabolic and respiratory illnesses even after adjustment for body mass index (BMI). We performed a prospective study to investigate the potential of NC to predict the need for invasive mechanical ventilation (IMV) in adult COVID-19 inpatients. MATERIALS AND METHODS: We prospectively and consecutively enrolled COVID-19 adult patients admitted to dedicated medical wards of two Italian hospitals from 25 March to 7 April 2020. On admission, clinical, biochemical and anthropometric data, including BMI and NC were collected. As primary outcome measure, the maximum respiratory support received was evaluated. Follow-up time was 30 days from hospital admission. RESULTS: We enrolled 132 subjects (55.0-75.8 years, 32% female). During the study period, 26 (19.7%) patients underwent IMV. In multivariable logistic regression analyses, after adjusting for age, sex, diabetes, hypertension and COPD, NC resulted independently and significantly associated with IMV risk (adjusted OR 1.260-per 1 cm increase 95% CI:1.120-1.417; P < .001), with a stronger association in the subgroup with BMI ≤30 Kg/m2 (adjusted OR 1.526; 95% CI:1.243-1.874; P < .001). NC showed a good discrimination power in predicting patients requiring IMV (AUC 0.783; 95% CI:0.684-0.882; P < .001). In particular, NC > 40.5 cm (>37.5 for females and >42.5 for males) showed a higher and earlier IMV risk compared to subjects with lower NC (Log-rank test: P < .001). CONCLUSIONS: NC is an easy to measure parameter able to predict the need for IMV in adult COVID-19 inpatients.


Subject(s)
COVID-19/mortality , Neck/pathology , Respiration, Artificial/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , Aged , COVID-19/epidemiology , COVID-19/therapy , COVID-19/virology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Survival Rate
12.
J Craniofac Surg ; 31(6): e644-e649, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1052245

ABSTRACT

At the end of December, 2019, a new virus was named severe acute respiratory syndrome coronavirus 2 appeared in Wuhan, China, and the disease caused is called as coronavirus disease 2019 (COVID-19) by World Health Organization, which to date having infected more than 3,588,773 people worldwide, as well as causing 247,503 deaths. A human to human transmission is thought to be predominantly by droplet spread, and direct contact with the patient or contaminated surfaces. This study aims to provide a comprehensive overview as well as to highlight essential evidence-based guidelines for how head and neck surgeon and healthcare providers need to take into consideration during their management of the upper airway during the COVID-19 pandemic safely and effectively to avoid the spread of the virus to the health provider.


Subject(s)
Airway Management , Betacoronavirus , Coronavirus Infections/prevention & control , Head/surgery , Neck/surgery , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Disease Outbreaks , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2 , Surgeons
13.
J Craniofac Surg ; 31(6): e630-e633, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1052243

ABSTRACT

The recent pandemic has led to an unprecedented overload of sanitary systems around the world. Despite that a maxillofacial department is not a frontline specialty in the treatment of coronavirus disease 2019 infections, our department has found itself faced with numerous problems in keeping the care system active and efficient while ensuring safety for patients and healthcare professionals. Massive redistribution of health personnel was needed to improve prevention and personal safety measures. The education and training system has been kept active, giving residents a decisive role in managing the state of emergency response. This article outlines new guidelines for infection prevention: from clinical control, treatment processes, clinical management, protection, and disinfection of healthcare professionals.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Head/surgery , Maxilla/surgery , Neck/surgery , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , COVID-19 , Coronavirus Infections/transmission , Humans , Pneumonia, Viral/transmission , SARS-CoV-2
14.
BMJ Case Rep ; 14(1)2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1020900

ABSTRACT

Here we present the case of a 37-year-old previously healthy man who developed fever, headache and a unilateral, painful neck swelling while working offshore. He had no known contact with anyone with COVID-19; however, due to the ongoing pandemic, a nasopharyngeal swab was performed, which was positive for the virus. After transfer to hospital for assessment his condition rapidly deteriorated, requiring admission to intensive care for COVID-19 myocarditis. One week after discharge he re-presented with unilateral facial nerve palsy. Our case highlights an atypical presentation of COVID-19 and the multifaceted clinical course of this still poorly understood disease.


Subject(s)
Alkalosis, Respiratory/blood , Bell Palsy/physiopathology , COVID-19/physiopathology , Myocarditis/physiopathology , Adult , Alkalosis, Respiratory/etiology , Blood Gas Analysis , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/therapy , Echocardiography , Edema/etiology , Electrocardiography , Humans , Hypotension/etiology , Hypotension/physiopathology , Lymphadenitis/etiology , Lymphadenitis/physiopathology , Magnetic Resonance Imaging , Male , Myocarditis/blood , Myocarditis/diagnostic imaging , Myocarditis/therapy , Natriuretic Peptide, Brain/blood , Neck , Oxygen Inhalation Therapy , Peptide Fragments/blood , Procalcitonin/blood , Recovery of Function , SARS-CoV-2 , Troponin T/blood , Vasoconstrictor Agents/therapeutic use
15.
Ear Nose Throat J ; 100(2_suppl): 148S-151S, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1013115

ABSTRACT

Patients with severe coronavirus disease 2019 (COVID-19) may have endothelial inflammation, pseudoaneurysm, and an increasing risk of bleeding, especially during surgical procedures. In this article, we reported 2 cases of COVID-19 patients with neck vascular lesions. The first patient had pseudoaneurysm of the cricothyroid artery, which was treated by percutaneous glue injection through ultrasonography guidance. The second patient presented lateral neck hematoma in front of the left superior thyroid artery, which was managed by coil endovascular embolization. In the context of pandemic, the management of vascular lesions may be performed through interventional radiological procedures that may reduce the risk of virus aerosolization and health care provider contamination.


Subject(s)
Adhesives/therapeutic use , Aneurysm, False/therapy , COVID-19/therapy , Embolization, Therapeutic/methods , Hematoma/therapy , Postoperative Complications/therapy , Radiology, Interventional , Tracheotomy , Aged , Aneurysm, False/complications , Aneurysm, False/diagnostic imaging , COVID-19/complications , Computed Tomography Angiography , Cyanoacrylates/therapeutic use , Endovascular Procedures , Hematoma/complications , Hematoma/diagnostic imaging , Humans , Male , Middle Aged , Neck , Postoperative Complications/diagnostic imaging , SARS-CoV-2 , Thyroid Gland/blood supply , Ultrasonography
16.
BMJ Case Rep ; 13(12)2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-999234

ABSTRACT

A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.


Subject(s)
COVID-19 , Drainage , Mediastinitis , Patient Care Management/methods , Postoperative Complications , Retropharyngeal Abscess , Thoracic Surgical Procedures/methods , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19/therapy , Catastrophic Illness/therapy , Diagnosis, Differential , Drainage/adverse effects , Drainage/methods , Humans , Infection Control/methods , Male , Mediastinitis/diagnosis , Mediastinitis/etiology , Mediastinitis/physiopathology , Mediastinitis/surgery , Middle Aged , Neck/diagnostic imaging , Neck/surgery , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/physiopathology , Retropharyngeal Abscess/surgery , SARS-CoV-2 , Treatment Outcome
17.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 55(12): 1165-1168, 2020 Dec 07.
Article in Chinese | MEDLINE | ID: covidwho-993623
18.
Lasers Surg Med ; 53(1): 115-118, 2021 01.
Article in English | MEDLINE | ID: covidwho-915164

ABSTRACT

INTRODUCTION: The COVID-19 pandemic requires us all to re-evaluate aesthetic practices to ensure optimal patient safety during elective procedures. Specifically, energy-based devices and lasers require special consideration, as they may emit plume which has been shown to contain tissue debris and aerosolized biological materials. Prior studies have shown transmission of viruses and bacteria via plume (i.e., HIV and papillomavirus). The purpose of this study was to evaluate plume characteristics of the Er:YAG resurfacing laser (Sciton; Palo Alto, CA) and compare it to the Morpheus8 fractional radiofrequency device (InMode; Lake Forest, CA). METHODS: Five patients who underwent aesthetic resurfacing and/or skin tightening of the face and neck were treated with the Er:YAG (Sciton Joule, Palo Alto, CA) and/or fractional radiofrequency (Morpheus8, Lake Forest, CA) between April 1 and May 11, 2020. Data collected included patient demographics, past medical history, treatment parameters, adverse events, particle counter data, as well as high magnification video equiptment. Patients were evaluated during treatment with a calibrated particle meter (PCE; Jupiter, FL). The particle meter was used at a consistent focal distance (6-12 inches) to sample the surrounding environment during treatment at 2.83 L/min to a counting efficiency of 50% at 0.3 µm and 100% at >0.45 µm. Recordings were obtained with and without a smoke evacuator. RESULTS: Of our cohort (n = 5), average age was 58 years old (STD ±7.2). Average Fitzpatrick type was between 2 and 3. Two patients received Er:YAG fractional resurfacing in addition to fractional radiofrequency during the same treatment session. Two patients had fractional radiofrequency only, and one patient had laser treatment with the Er:YAG only. There were no adverse events recorded. The particle counter demonstrated ambient baseline particles/second (pps) at 8 (STD ±6). During fractional radiofrequency treatment at 1-mm depth, the mean recording was 8 pps (STD ±8). At the more superficial depth of 0.5 mm, recordings showed 10 pps (STD ±6). The Er:YAG laser resurfacing laser had mean readings of 44 pps (STD ±11). When the particle sizes were broken down by size, the fractional radiofrequency device had overall smaller particle sizes with a count of 251 for 0.3 µm (STD ±147) compared with Er:YAG laser with a count of 112 for 0.3 µm (STD ±84). The fractional radiofrequency did not appear to emit particles >5 µm throughout the treatment, however, the Er:YAG laser consistently recorded majority of particles in the range of 5-10 µm. The addition of the smoke evacuator demonstrated a 50% reduction in both particles per second recorded as well as all particle sizes. CONCLUSION: Re-evaluation of the plume effect from aesthetic devices has become important during the COVID-19 pandemic. Further studies are required to characterize viability of COVID-19 viability and transmissibility in plume specimens. Based on this pilot study, we recommend that devices that generate little to no plume such as fractional radiofrequency devices be used in Phase I reopening of practice while devices that generate a visible plume such as Er:YAG laser resurfacing devices be avoided and only used with appropriate personal protective equipment in addition to a smoke evacuator in Phase IV reopening.


Subject(s)
COVID-19/transmission , Cosmetic Techniques/instrumentation , Laser Therapy/instrumentation , Lasers, Solid-State/therapeutic use , Radiofrequency Ablation/instrumentation , Skin Aging/radiation effects , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Cohort Studies , Face , Female , Humans , Male , Middle Aged , Neck , Particle Size , Pilot Projects , Risk Assessment
19.
Otolaryngol Head Neck Surg ; 162(6): 804-808, 2020 06.
Article in English | MEDLINE | ID: covidwho-913947

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) pandemic has unfolded with remarkable speed, posing unprecedented challenges for health care systems and society. Otolaryngologists have a special role in responding to this crisis by virtue of expertise in airway management. Against the backdrop of nations struggling to contain the virus's spread and to manage hospital strain, otolaryngologists must partner with anesthesiologists and front-line health care teams to provide expert services in high-risk situations while reducing transmission. Airway management and airway endoscopy, whether awake or sedated, expose operators to infectious aerosols, posing risks to staff. This commentary provides background on the outbreak, highlights critical considerations around mitigating infectious aerosol contact, and outlines best practices for airway-related clinical decision making during the COVID-19 pandemic. What otolaryngologists need to know and what actions are required are considered alongside the implications of increasing demand for tracheostomy. Approaches to managing the airway are presented, emphasizing safety of patients and the health care team.


Subject(s)
Airway Management/standards , Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Otolaryngologists/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Tracheostomy/standards , Airway Management/methods , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Female , Head/surgery , Humans , Male , Neck/surgery , Occupational Health , Pandemics/statistics & numerical data , Patient Safety , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , SARS-CoV-2 , Safety Management/methods , Safety Management/standards
20.
Ann Thorac Surg ; 110(5): e417-e419, 2020 11.
Article in English | MEDLINE | ID: covidwho-884669

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 disease 2019 (COVID-19) has rapidly spread worldwide since December 2019. An acute respiratory distress syndrome develops in a relevant rate of patients, who require hospitalization. Among them, a nonnegligible rate of 9.8% to 15.2% of patients requires tracheal intubation for invasive ventilation. We report the case of a pneumomediastinum and subcutaneous emphysema developing in a COVID-19 patient secondary to postintubation tracheal injury. The management of COVID-19 patients can be challenging due to the risk of disease transmission to caregivers and epidemic spread. We performed a bedside tracheal injury surgical repair, after failure of conservative management, with resolution of pneumomediastinum and subcutaneous emphysema and improvement of the patient's conditions.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Intubation, Intratracheal/adverse effects , Mediastinal Emphysema/surgery , Pneumonia, Viral/therapy , Subcutaneous Emphysema/surgery , Thoracic Surgical Procedures/methods , Trachea/injuries , Aged , COVID-19 , Coronavirus Infections/epidemiology , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/etiology , Neck , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/etiology , Tomography, X-Ray Computed
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