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Revista de la Facultad de Medicina Humana

Print version ISSN 1814-5469On-line version ISSN 2308-0531

Rev. Fac. Med. Hum. vol.20 no.3 Lima Jul-Sep 2020 


Impact of COVID-19 on cervicofacial surgery

Cesar Espinoza- Chiong1  , Medical Resident

1Servicio de Cirugía de Cabeza, Cuello y Maxilofacial, Hospital Guillermo Almenara Irigoyen. Lima, Perú

Dear Editor

The new coronavirus disease 2019 (COVID-19) with an epidemic center in Wuhan City, China, was declared an international public health emergency in late January by the World Health Organization (WHO)1. The first confirmed case in Peru was on March 6 and, in less than two weeks, the infectious disease was declared a national health emergency, reporting more than 20,000 cases and 572 deaths by April 232.

The transmission of COVID-19 among humans occurs mainly through respiratory secretions; fecal-oral transmission has also been confirmed; therefore, those health workers who handle patients with aerodigestive tract diseases such as dentists, otolaryngologists, head and neck surgeons, pulmonologists, respiratory therapists, speech therapists, and infectologists are at greater risk of contagion. The first reported case in Wuhan of contagion in a surgical team occurred during video-assisted surgery where 14 health workers were infected3and the first overall reported fatality of medical staff was from an otolaryngologist in Wuhan city on January 254. Therefore, it is essential to alert all professionals who need to examine the cervicofacial region; whether working with or without access to high aerodigestive pathways, eye examination, rehabilitation procedures or even regional hygiene, the risk of contagion is high, given exposure to mucous membranes and secretions with potential high viral load.

Contamination of surgical equipment exposed to aerosol-generating procedures, such as endotracheal intubation, extubation, noninvasive ventilation, and open-circuit aerosol exposure in tracheotomies and flexible laryngoscopies, has also been reported5,6. Due to the high risk of infection in these specialists, the Sociedad Peruana de Cirugía de Cabeza, Cuello y Maxilofacial (SPCCMF) issued a document recommending deferring elective surgeries and external consultations, except for emergencies; restrict medical visits in areas of hospitalization, as well as recommendations in cervical-facial procedures in the context of the pandemic, with special attention to tracheotomies, abscesses, and traumas7.

Most patients treated by head and neck surgeons have cancer that is a major clinical problem because they have a more complex therapeutic strategic plan and aftercare. The evaluation of a multidisciplinary team allows us to consider the risk/benefit before a likely change in the approach to the treatment of these patients10) In the case of patients with carcinomas of the upper aerodigestive tract, where the treatment of choice is surgical, it is important for the identification of cases with diagnostic tests COVID-19 to reduce the risk of viral contamination, both for the patients and health workers. The objective is to minimize the risk of loss of timely surgical treatment and anticipate the increase in the number of patients to be treated at the end of the pandemic, taking into account the degree of urgency, the difficulty of surgery, and the risk of contamination11,12

Concerning personal protection, the SPCCMF specifies the use of personal protection equipment (PPE) necessary in any operating room procedure or surgical intervention, training of the surgical team in the correct use of PPE before any procedure, limitation of personnel in the operating room and appropriate specific sterilization measures to avoid contamination(7). One of the most important reasons to explain the virus infection in health workers may be related to the non-use of PPE and poor education about the correct use of it13

The world is experiencing an unprecedented pandemic where the viral infection is mainly due to exposure to respiratory secretions and the treatment of the disease is still uncertain. Rigorous compliance with prevention measures, infection control, attention to rapidly changing policies and procedures are essential to reduce risk and mitigate the spread among patients and these specialists.


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2. Covid 19 en el Perú - Ministerio del Salud [Internet]. 2020 [citado 2 de mayo de 2020]. Disponible en: ]

3. Kulcsar MA, Montenegro FL, Arap SS, Tavares MR, Kowalski LP. High Risk of COVID-19 Infection for Head and Neck Surgeons. Int Arch Otorhinolaryngol. abril de 2020;24(2):e129-30. [ Links ]

4. Lüers J-C, Klußmann JP, Guntinas-Lichius O. [The Covid-19 pandemic and otolaryngology: What it comes down to?]. Laryngorhinootologie. 26 de marzo de 2020; DOI: 10.1055/a-1095-2344. [ Links ]

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6. Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review. Anaesthesia. 2020;75(7):920-7. DOI: 10.1111/anae.15071 [ Links ]

7. Recomendaciones de la Sociedad Peruana de Cirugia Cabeza, Cuello y Maxilofacial con respecto a la atencion y procedimientos durante la pandema de COVID-19 [Internet]. 2020. Disponible en: [ Links ]

8. Tay JK, Khoo ML-C, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Neck Surg [Internet]. 31 de marzo de 2020 [citado 2 de mayo de 2020]; Disponible en: [ Links ]

9. 139939. Tracheotomy Recommendations During the COVID-19 Pandemic [Internet]. American Academy of Otolaryngology-Head and Neck Surgery. 2020 [citado 2 de mayo de 2020]. Disponible en: ]

10. De Felice F, Polimeni A, Valentini V. The impact of Coronavirus (COVID-19) on head and neck cancer patients' care. Radiother Oncol J Eur Soc Ther Radiol Oncol. 24 de marzo de 2020;147:84-5. DOI: 10.1016/j.radonc.2020.03.020. [ Links ]

11. Shuman AG, Campbell BH. Ethical framework for head and neck cancer care impacted by COVID-19. Head Neck [Internet]. n/a(n/a). Disponible en: ]

12. Fakhry N, Schultz P, Morinière S, Breuskin I, Bozec A, Vergez S, et al. French consensus on management of head and neck cancer surgery during COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis [Internet]. 11 de abril de 2020; Disponible en: [ Links ]

13. Koh D. Occupational risks for COVID-19 infection. Occup Med Oxf Engl. marzo de 2020;70(1):3-5. DOI: 10.1093/occmed/kqaa036. [ Links ]

Financing: Self-financed.

Received: May 10, 2020; Accepted: June 03, 2020

Correspondence:Cesar Espinoza Chiong Address: Av. Esteban Campodonico 540. Sta Catalina. La Victoria, Lima-Perú. Telephone number: 951 733 892

Authorship contributions: The author participated in the genesis of the idea, analysis, and preparation of this manuscript.

Conflicts of interest: The author declares that he has no conflict of interest.

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons