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Physicians and other healthcare workers who perform and participate in examinations and procedures within the head and neck region and airway are at particularly high risk of exposure and infection from aerosol and droplet contamination. Authors have developed recommendations to give broad guidance to practitioners. Non urgent appointments should be postponed to limit the chance of SARS-CoV-2 infection of patients or healthcare workers during their visit to the facility. This may include postponing appointments for patients with benign disease (e.g. benign salivary or thyroid tumours, hyperparathyroidism) or patients undergoing routine surveillance visits after treatment for head and neck cancer. In all instances, patients should be queried by telephone about any new or concerning signs or symptoms that may suggest disease recurrence and/or pending issues, such as severe dysphagia or airway compromise, as well as current symptoms suggestive of COVID-19. Endoscopic examinations of the nose, sinuses, oropharynx, hypopharynx, and larynx are considered aerosol generating procedures. Moreover, the nose and nasopharynx have been shown to be reservoirs for high concentrations of the SARSCoV-2virus, and after manipulation, viral particles have been shown to be airborne for three hours or more. Examinations should be limited to patients who have a clear indication and need. Examination should be performed by the most experienced personnel available in an expedient fashion. Use of sprays for anaesthesia should be avoided. Office-based laryngeal biopsy, injection, laser, or other procedures should be delayed if possible. Determine the COVID-19 status of the patient before surgery; the procedure should be postponed in patients testing positive with COVID-19. It is advisable that during intubation and extubation, all nonessential staff leave the room and only return after the airway is secured. Endoscopic nasal operations, including sinus surgery and transsphenoidal pituitary surgery, tracheostomy, mastoidectomy are high-risk procedures. PPE for all operating room staff is recommended.

Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic.
Givi B, Schiff BA, Chinn SB, et al.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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