Larynx/Hypopharynx (high risk for viral aerosolization)
Begin with baseline airway evaluation to rule out risk of aspiration
and/or the likelihood of becoming “at risk” for airway
obstruction12. Nutritional status should also be
evaluated, such as the patient’s ability to feed by mouth versus being
nasogastric/PEG-dependent.
- Early disease
- Proceed with non-surgical treatment
- Consider deferral with close-interval telemedicine visits
- Intermediate disease
- Proceed with non-surgical treatment
- Advanced disease
- Proceed with non-surgical treatment where appropriate
- Primary surgery for patients presenting with advanced cartilage
invasion, extra-laryngeal spread, recurrent disease, or high risk
for aspiration post chemoradiation therapy
- Favor neo-adjuvant systemic therapy if surgery is indicated to allow
deferral past peak incidence of pandemic
Sinonasal and Skull base
(high risk for viral aerosolization)
All endoscopic sinus surgery/endoscopic endonasal approaches are
considered high risk procedures for viral
aerosolization13, therefore all routine nasal
endoscopy and debridement for follow-up should deferred when possible.
Patients with inflammatory disease or non-malignant tumors should be
deferred. Alternative non-surgical interventions should be considered
for patients with active malignancies requiring treatment.
- Intermediate stage tumors
- Consider for chemoradiation or radiation therapy alone
- Advanced mucosal derived malignancies
- Sinonasal undifferentiated carcinoma or Squamous cell carcinoma
should be considered for neoadjuvant chemotherapy
- Sinonasal mucosal melanoma should be considered for neoadjuvant
immunotherapy or targeted therapy
- Skull base sarcomas should be considered for radiation therapy
- Low grade and slow growing neuroendocrine carcinoma (NEC) and
olfactory neuroblastoma (ONB)
- Defer and monitor with periodic imaging
- Tumors of minor salivary gland origin
- Defer and monitor with periodic imaging unless rapidly growing
- High grade NEC and Hyams Grade IV ONB
- Consider neoadjuvant chemotherapy
Patients with unavoidable, emergent surgery (i.e. invasive fungal
sinusitis, impending visual or neurological compromise): we recommend
full PAPR equipment for all involved in the case and minimize
nonessential personnel in the operating room (trainees, advanced
practice providers, visitors, etc.).