General considerations
- Ideally, where testing is readily and rapidly available, SARS-CoV-2
testing should be performed on all patients with mucosal lesions prior
to HNS evaluation, and/or, at the least, 1 day prior to the planned
surgery.
- Selected patients may be closely observed allowing for
deferral/rescheduling of surgery.
- Significant functional loss or life-threatening disease requires
immediate attention.
- Telemedicine is an essential tool in several medical fields during
these times and has been recommended to be used when deemed
appropriate by the American Academy of Otolaryngology-Head and Neck
Surgery8.
- At our institution, as a general guideline for scheduling, cases are
deferred when performed for prophylactic intent, benign diseases,
conditions unlikely to be adversely affected by an 8-12-week surgical
delay, or for conditions which have available and appropriate
alternative therapies.
- In-depth discussion and review is performed when patients have a
severely depressed performance status, high comorbidity burden and/or
advanced age, or when surgical cases may require significant blood
transfusion (>4 units), ICU care, or a prolonged
hospitalization is anticipated.
- While multi-modality input is sought after pre-operatively for
patients requiring multi-modality therapy, we suggest deferring all
head and neck radiation and medical oncology consultations to when
needed to minimize exposure risks, unless neoadjuvant treatment is
considered.
- Flexible naso-pharyngo-laryngoscopies are limited to when medically
necessary. When performed, they are recorded by the healthcare
provider for shared review to eliminate duplicate exposure risk.