Head and Neck Practice in the COVID-19 Pandemics Today: A Rapid Systematic Review

Abstract

Introduction Head and neck specialists and otorhinolaryngologists are greatly exposed to coronavirus disease 2019 (COVID-19) transmission in their everyday praxis. Many articles are being published regarding medical staff protection and patient management during the pandemic. Objective To provide an easy access to and a trustful review of the main aspects that have changed in the head and neck surgery and otorhinolaryngology practice due to the COVID-19 pandemic. Data Synthesis The search terms used were: (head and neck or otorhinolaryngology or ORL or thyroid) AND (severe acute respiratory syndrome coronavirus 2 [SARS-COV-2] or COVID-19 or CORONAVIRUS). The results were limited to the year of 2020. Articles were read in English, Portuguese, French, German, and Spanish or translated from Chinese. All included articles were read by at least two authors. Thirty-five articles were included. Most articles suggest postponing elective surgeries, with exception to cancer surgeries, which should be evaluated separately. Twenty-five articles recommended some kind of screening prior to surgery, using polymerase chain reaction (PCR) tests and epidemiological data. Extra precautions, such as use of personal protective equipment (PPE), are suggested for both tracheostomies and endoscopies. Fifteen articles give recommendation on how to use telemedicine. Conclusion The use of PPE (N95 or powered air-purifying respirator [PAPR]) during procedures should be mandatory. Patients should be evaluated about their COVID-19 status before hospital admission. Cancer should be treated. Tracheostomy tube cuff should be inflated inside the tracheal incision. All COVID-19 precautions should be kept until there is a validated antiviral treatment or an available vaccine.

Thyroid surgery during the COVID-19 pandemic: results from a systematic review

“…2-3 days) as reported in five studies [25][26][27][28]30]. Also, the time in the operating room was similar to that of thyroid surgery apart to the COVID-19 pandemic, as reported by two studies [27,30]; however, mean longer periods may be expected since the recommendations to keep the spread of SARS-CoV-2 low in operating rooms [1,19]. Complications after surgery, including hypoparathyroidism, haematoma, and recurrent laryngeal nerve injury, were found to be higher compared to that usually associated with thyroid surgery before the COVID-19 pandemic [33]: however, most of the complicated cases were due to postoperative hypoparathyroidism, for which it was not known to be transient or permanent.…”

“…During the Covid-19 pandemic, two main reasons for the postponement of elective thyroid surgery are the risk of transmission of SARS-CoV-2 and the need for a better allocation of health resources [ 1 , 2 ]. Nevertheless, the current trend of COVID-19 indicates that in large parts of the world this pandemic may continue much longer than expected and may become endemic [ 31 ].…”

“…Overall, thyroid surgery is quicker and requires fewer resources than other most demanding surgeries of the head and neck [ 1 , 2 , 31 ]. Current recommendations may not be valid in the scenario where COVID-19 becomes endemic, so we need evidence-based data to support the gradual resumption of elective surgery while living with the SARS-CoV-2 virus [ 31 ].…”

“…Elective surgeries have been almost totally postponed to keep to a minimum the risk of transmission of SARS-CoV-2 and also to allow a better allocation of resources [1,2]. Since thyroid surgery usually does not cover immediate surgical interventions, during the COVID-19 pandemic nearly all of the patients who require thyroid surgery care are experiencing delays in the operation planning procedure [3][4][5][6].…”

Charting the Unknown Association of COVID-19 with Thyroid Cancer, Focusing on Differentiated Thyroid Cancer: A Call for Caution

“…The COVID-19 pandemic has created novel barriers to safe head and neck surgery due to intense SARS-CoV-2 replication in the upper aerodigestive tract and aerosol generating head and neck surgical procedures. Thus, a systematic review on head and neck practice during the COVID-19 pandemic inferred that the cancer should be treated in compliance with specific protection measures for medical staff and specific guidelines for patient management [ 79 ].…”