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.

Keywords: COVID-19; SARS-CoV-2; head and neck; otorhinolaryngology; surgery.

Fig. 1 Selection Diagram

Six papers that were included in our main results have not been specifically cited in our findings but were considered in our main results.

Fig. 2

Distribution of the 35 papers selected according to the publication type.

Fig. 3 Screening Recommendations

The articles selected were distributed in six categories according to the findings related to screening for coronavirus 2019 (COVID-19): those that recommended only epidemiological screening ( n  = 5), those that recommended nasopharynx swab polymerase chain reaction (PCR) prior to surgery ( n  = 8), those that recommended epidemiological screening prior to consult combined with nasopharynx swab PCR prior to surgery ( n  = 9), those that recommended PCR in urgent situations ( n  = 1), those that recommended some kind of screening but did not specify the type ( n  = 3), and those that did not have any kind of recommendation ( n  = 9).

Fig. 4 Level of protection recommended for head and neck surgery in the context of COVID-19 pandemic

Level 3 consists of complete gown and powered air purifying respirator (PAPR); level 2 consists of complete gown and N95 mask, and non-specific instructions consist of a combination of levels 2 and 3 recommendations based on polymerase chain reaction results.

Fig. 5 Telemedicine Recommendations

The graphic divides into categories the articles that recommended the use of telemedicine specifically for triage, routine consults, and patient revaluation ( n  = 15); the ones that recommended the use of telemedicine, but did not specify for what situations ( n  = 4), and those that did not have any comment related to telemedicine ( n  = 16).