key: cord-0858151-c3ab7uxm
authors: Wunsch, Annette; Pitak-Arnnop, Poramate
title: Strategic planning for maxillofacial trauma and head and neck cancers during COVID-19 pandemic– December 2020 updated from Germany
date: 2021-01-26
journal: Am J Otolaryngol
DOI: 10.1016/j.amjoto.2021.102932
sha: 8d8c9cbdfc1c425a2dec7b4c0666bbccf7019f5c
doc_id: 858151
cord_uid: c3ab7uxm

nan

We read with great interest the review on otorhinolaryngology/head and neck surgery (ORL-HNS) practice during the COVID-19 pandemic recently published in this journal by Salari [1] . We would like to share our current protocol for organizing ORL-HNS patient care in Germany (updated in December 2020) (Fig. 1) .

In Germany, all recommendations concerning infections have been developed by the Robert Koch Institute (RKI), a German governmental organization responsible for disease control and prevention and related researches. Until December 2, 2020, the RKI announced a total of 1,084,743 COVID-19 cases with a mortality rate of ca. 1.6% in this country (more details on https://www.rki.de). The lockdown measure has been forced again since November 1, 2020 to combat with the Coronavirus second wave. On the other hand, the curfew also hampers hospital volume. The University Hospital of Leipzig, Germany, recently revealed a significant decrease in maxillofacial/head and neck surgeries during the curfew [2] . This inevitably affects not health care economy but medical education and residency training. pandemic. This guideline can be applied only for otolaryngologists but also for maxillofacial surgeons, dentists and pneumologists, who often contact with the patient's airway [3, 4] . During this COVID-19 second wave, the RKI recommends the antigen (quick) test as a screening method, in addition to standard real-time polymerase chain reaction (RT-PCR) test, for all patients undergoing hospitalization. The patients with COVID-19 symptoms will be immediately isolated until the RT-PCR test is launched, because the quick has lower sensitivity (≥80%) and specificity (≥ 97%) than the RT-PCR test (98.8% to 99.7% sensitivity; 97.8% to 98.6% specificity). Moreover, it is noteworthy that the "positive" quick test is commonly seen when the symptom begins. Conversely, the RT-PCR test can be positive during the inoculation of the infection until after the infection heals. Last but not least, operating theater management must depend not only on the priority (surgical indication) but also on the patient's symptoms, history and test results related to COVID-19 ( Fig. 1) If impossible to wait, operation with PPE Fig. 1 Flow chart showing the current patient management during the COVID-19 second wave in Germany, updated in December 2020 [3] [4] [5] .

Note: * If a CT or MRI is needed for diagnosis and treatment planning for head and neck diseases, the patient "with ≥ 1 COVID-19 symptoms" should receive extended CT/MRI to the thorax. ⁋ In Germany, the surgical indications are roughly divided into 5 subgroups [5] : N0 with the highest priority requires immediate surgery, e.g. life-threatening trauma; N1 with high priority requires surgery when an operating theater is available, e.g. massive retrobulbar hematoma with visual changes after facial fracture;

N2 with emergent priority goes to the surgery within 6 hours after adequate fasting time, e.g. deep neck infection that can cause airway obstruction; N3 with normal priority (mainly elective cases) can be delayed until the end of elective procedural program, probably 12-24 hours, e.g. skin tumors;

and urgency priority, e.g. recurrent epitaxis in patients with anticoagulants.

Contact with a COVID-19 patient/carrier within 14 days

Living in a risky COVID-19 area (or staying ≥ 48 hours)

Antigen Test (Quick Test)

"and" 

What is the best treatment option for head and neck cancers in COVID-19 pandemic? A rapid review

Impact of Corona virus disease 2019 on oral and maxillofacial surgery: Preliminary results after the curfew

Interdisziplinär abgestimmte Empfehlungen zum Personal-und Patientenschutz bei Durchführung planbarer Eingriffe zur Zeit der SARS-CoV-2-Pandemie der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde

Präoperative Coronavirustestung in Deutschland

Erfahrungsberichte zum Umgang mit den Empfehlungen der Deutschen Gesellschaft für Hals-Nasen

Glossar perioperativer Prozesszeiten und Kennzahlen -Version