Craniomaxillofacial Trauma and Urgent Otolaryngologic Conditions
As emergency departments across the United States continue to serve
patients with urgent medical needs, individuals who present with facial
trauma, uncontrolled epistaxis, abscesses, and other conditions will
require urgent management by otolaryngologists, including bedside
procedures or operative intervention. Given our current understanding of
COVID-19, the nasopharynx and nasal cavity harbor the highest viral load
and protective precautions must be enforced with addressing injuries or
urgent conditions in this location. We recommend the use of enhanced PPE
for providers performing bedside procedures on patients with unknown,
suspected, or positive COVID-19 status including repair of facial
lacerations, management of animal bite wounds, control of epistaxis,
peritonsillar abscess drainage, or any other condition requiring
invasive examination or instrumentation of the oral cavity, oropharynx,
nasal cavity, or nasopharynx. Enhanced PPE is indicated due to the
increased risk aerosolization of saliva and nasal secretions in this
setting. Patients presenting with operative facial fractures (e.g.
orbital, mandibular, nasal, Le Fort pattern fractures, etc.), require
preoperative COVID-19 diagnostic testing 48 hours prior to proceeding
with elective surgical intervention with the patient kept in strict
quarantine pending test results. In scenarios warranting emergent
surgical intervention (e.g. rectus muscle entrapment, retrobulbar
hemorrhage, flail mandible fractures, etc.) all operating room staff
must utilize enhanced PPE as the COVID-19 status for these patients is
unknown and should be presumed positive.