ABSTRACT
The COVID-19 pandemic has raised concern of viral transmission during
otolaryngological procedures by means of droplets/saliva. The use of PPE
and isolation settings are mandatory during surgery. This paper
describes the development of the STAPID setting to reduce salivary
spread during a sialendoscopy-assisted transfacial removal of a parotid
stone.
1. INTRODUCTION
Severe-Acute-Respiratory-Syndrome Coronavirus 2 (SARS-CoV-2), a novel
highly-transmissible respiratory coronavirus, was responsible of
coronavirus disease 2019 (COVID-19) since December 2019. On March 11,
2020 the World Health Organization (WHO) declared COVID- worldwide
pandemic. Person-to-person transmission occurs primarily through
droplets spread by coughing or sneezing from an infected individual or
via direct contact. Recently, the virus has also been detected
in saliva samples, thus making saliva a potential transmission route
for COVID-19; in fact, To et al. tested SARS-CoV- saliva samples from 12
patients: all but one were positive with a decreasing viral load trend
[1]. A SARS-Cov-2 tropism for the epithelial salivary ducts cells
through angiotensin-converting enzyme 2 (ACE2) receptors was described
in rhesus macaques [1]. This suggests the possibility of SARS-CoV-2
salivary infection, although its detection in saliva may be partially
related to the contribution, in this milieu , of secretions from
the nasopharynx or the lower airways. It has been recently hypothesized
that the infection of SARS-CoV-2 could favour acute sialadenitis and,
after the acute phase, chronic sialadenitis as a consequence of fibrosis
repairment [2]. It is not a casualty that we recently described a
SARS-CoV-2 positive patient whose first clinical manifestation was an
acute non-suppurative parotitis [3]. During this pandemic, patients
continue to come with urgent head and neck pathologies requiring
surgery. A general consensus exists on high risks of contagion by
SARS-CoV-2 during otolaryngological procedures that may determine an
aerosolisation with nosocomial amplification of the infection. Moreover,
procedures requiring close contact with saliva, such as surgical
procedures for salivary gland disease with a transoral and/or combined
oral and external approach [4], may determine the risk of spreading
the infection by means of salivary contamination. For those reasons, the
use of particular Personal Protective Equipment (PPE) and isolation
settings are mandatory to protect health-workers, especially
otolaryngologists. We here describe our experience developing the STAPID
(Sialendoscopy-assisted Transfacial Approach to Parotid gland and duct
Isolation Drape setting) to reduce salivary spread in and around the
surgical field during a sialendoscopy-assisted transfacial removal of a
parotid stone causing recurrent episodes of gland abscess.