Current Approach for Oral and Maxillofacial Surgery Interventions During COVID-19 Pandemic

Yıl 2020, Cilt: 6 Sayı: 2, 42 - 49, 26.08.2020

Koray Onur Şanal

Öz

COVID-19 pandemic is a problem that closely concerns oral and maxillofacial surgery. The aim of this review is to guide healthcare workers by providing a perspective on the maintenance of oral and maxillofacial surgery patients during pandemic. The keywords of coronavirus disease, COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transmission, pandemic, oral surgery, personal protective equipment were searched on electronic databases (Google Academic, Pubmed, ScienceDirect, and Turkish Ministry of Health), until 11 July 2020. Literature search was conducted in English and Turkish languages. Health care workers accounted for 1/3 of the cases in China in the early period of the pandemic. It was necessary to postpone many elective procedures and give priority to emergency treatments in oral and maxillofacial surgery applications in our country and in the world. Healthcare providers should quickly identify emergency response procedures during outbreak. Thus, excessive load and waste of resources on the health system can be prevented. Infection control policies should be determined to prevent cross infections between inpatients and outpatients. The capacity of COVID-19 to spread rapidly through droplets necessitates the correct use of personal protective equipment. It is necessary to avoid the aerosol-generating procedures, but if these procedures are necessary, isolation of the environment should be provided. It is important that the guides used in the management of the problems that may be unique to oral and maxillofacial surgery do not conflict with the applications of other disciplines. Each healthcare institution should create flexible models that it can implement within its own means, in the transition period to elective procedures. Necessary policies should be used for the continuity of personal protective equipment. During the epidemic, collaborations should be established between different health institutions. Negative pressure rooms are recommended in elective surgeries. When planning elective surgeries during the gradual reopening process, short-term treatments should be considered against the possibility of a second wave. Every effort should be made to perform elective surgical procedures without causing any transmissions.

Anahtar Kelimeler

Transmission, COVID-19, Personal protective equipment, Maxillofacial surgery, SARS-CoV-2

COVID-19 Pandemisinde Oral ve Maksillofasiyal Cerrahi Uygulamalarına Güncel Bakış

Öz

COVID-19 pandemisi, yayılımının öncelikle solunum bölgesinden kaynaklanması sebebiyle oral ve maksillofasiyal cerrahiyi yakından ilgilendiren bir sorundur. Bu derlemenin amacı, pandemi sürecinde oral ve maksillofasiyal cerrahi hastalarının idamesine yönelik bir bakış açısı sağlayarak sağlık çalışanlarına bir rehber sunmaktır. Google Akademik, Pubmed, ScienceDirect elektronik veri tabanları ile Sağlık Bakanlığı ait verilerin koronavirüs hastalığı, COVID-19, şiddetli akut solunum sendromu koronavirüs 2 (SARS-CoV-2), bulaşma, pandemi, oral cerrahi, kişisel koruyucu ekipman anahtar kelimeleri Türkçe ve İngilizce 11 Temmuz 2020 tarihine kadar tarandı. Pandeminin erken döneminde Çin’deki vakaların üçte birini sağlık çalışanları oluşturmaktaydı. Ülkemizde ve Dünya’da oral ve maksillofasiyal cerrahi uygulamalarında birçok elektif prosedürlerin ertelenmesi, acil tedavilere öncelik verilmesi gerekmiştir. Pandemi sırasında sağlık sunucuları süratle acil müdahale prosedürlerini tanımlamalıdır. Böylece sağlık sistemi üzerinde oluşabilecek aşırı yükün ve kaynak israfının önüne geçilebilir. Serviste yatan hastalar ile ayaktan tedavi gören hastalar arasında çapraz enfeksiyonların önüne geçebilmek için enfeksiyon kontrol önlemleri belirlenmelidir. COVID-19’un damlacık yoluyla hızla yayılma kabiliyeti kişisel koruyucu ekipmanların doğru kullanımını zorunlu kılmaktadır. Aerosol üreten prosedürlerden kaçınmak gerekir ancak bu işlemlerin uygulanma zorunluluğu varsa ortamın izolasyonu sağlanmalıdır. Oral ve maksillofasiyal cerrahiye özgü sorunların yönetiminde kullanılan kılavuzların diğer disiplinlerin uygulamalarıyla çelişmemesi önemlidir. Elektif işlemlere geçiş döneminde, her sağlık kuruluşu kendi imkanları çerçevesinde uygulayabileceği esnek modeller oluşturmalıdır. Kişisel koruyucu ekipman sürekliliği konusunda gerekli önlemler alınmalıdır. Salgın döneminde farklı sağlık kurumları arasında iş birlikleri oluşturulmalıdır. Elektif cerrahilerde negatif basınçlı odaların kullanımı önerilir. Kademeli yeniden açılma sürecinde elektif cerrahileri planlarken ikinci bir dalga ihtimaline karşı kısa vadeli tedaviler düşünülmelidir. Elektif cerrahi işlemlerin bulaşa neden olmadan gerçekleştirilebilmesi için her türlü çaba gösterilmedir.

Anahtar Kelimeler

bulaşma, COVID-19, Kişisel koruyucu ekipman, Maksillofasiyal cerrahi, SARS-CoV-2

Kaynakça

• 1. Onder G, Rezza G, Brusaferro S. Case fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020; doi: 10.1001/jama.2020.4683, (Baskıda).
• 2. Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis 2020; 20(6): 669-677.
• 3. Study of Scientific Advisory Board. COVID-19 (Infection of SARS-CoV-2) General information, epidemiology and diagnosis. T. C. Ministry of Health [İnternet yayını]. 2020 [atıf 30.05.2020. Erişim: https://hsgm.saglik.gov.tr/depo/covid19/Ingilizce/Rehber/COVID-19_Rehberi__Genel_bilgiler_epidemiyoloji_ve_tani_8.06.2020_eng.pdf.
• 4. Cheng ZJ, Shan J. 2019 novel coronavirus: where we are and what we know. Infection 2020; 48(2): 155-163.
• 5. Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr 2020; 87(4): 281-286.
• 6. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; doi: 10.1001/jama.2020.1585 (Baskıda).
• 7. Adams JG, Walls RM. Supporting the health care workforce during the Covid-19 global epidemic. JAMA 2020; 323(15): 1439-1440.
• 8. Ti LK, Ang LS, Foong TW, Wei BS. What we do when a COVID-19 patient needs an operating room preparation and guidance. Can J Anesth/J Can Anesth 2020; 67(6): 756-758.
• 9. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020; 382(16): 1564-1567.
• 10. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020; 382(12): 1177-119.
• 11. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020; 12(1): 9.
• 12. Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. J Craniomaxillofac Surg 2020; 48(5): 521-526.
• 13. Brücher BLDM, Nigri G, Tinelli A, Lapena Jr JFF, Espin-Basany E, Macri P, et al. COVID-19: Pandemic surgery guidance. 4open 2020; 3: 1.
• 14. COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020; doi: 10.1002/bjs.11646 (Baskıda).
• 15. Michetti CP, Burlew CC, Bulger EM, Davis KA, Spain DA. Performing tracheostomy during the Covid-19 pandemic: guidance and recommendations from the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma. Trauma Surg Acute Care Open 2020; 5(1): e000482.
• 16. Cesari M, Proietti M. Geriatric medicine in Italy in the time of COVID-19. J Nutr Health Aging 2020; 24(5): 459-460.
• 17. Study of Scientific Advisory Board. Study guide and infection control policy in healthcare institutions at the time COVID-19 Pandemic. T.C. Ministry of Health [İnternet yayını. 2020 [atıf 09.07.2020. Erişim: https://covid19bilgi.saglik.gov.tr/depo/rehberler/saglik-kurumlarinda-calisma-rehberi-ve-enfeksiyon-kontrol-onlemleri/COVID-19_SAGLIK_KURUMLARINDA_CALISMA_REHBERI_VE_ENFEKSIYON_KONTROL_ONLEMLERI.pdf
• 18. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesth/J Can Anesth 2020; 67(5): 568–576.
• 19. Coccolini F, Perrone G, Chiarugi M, Di Marzo F, Ansaloni L, Scandroglio I, Marini P et al. Surgery in COVID-19 patients: operational directives. World J Emerg Surg 2020; 15(1): 25.
• 20. Elizabeth Brindle M, Gawande A. Managing COVID-19 in Surgical Systems. Ann Surg 2020; 272(1): e1-e2.
• 21. T.C. Ministry of Health. Infection control policy in operation rooms at the time of COVID-19 pandemic. T.C. Ministry of Health [İnternet yayını]. 2020 [atıf 27.04.2020]. Erişim: https://covid19bilgi.saglik.gov.tr/depo/enfeksiyon-kontorl-onlemleri/COVID19-PandemiDonemindeAmeliyathanelerdeAlinacakEnfeksiyonKontrolOnlemleri.pdf
• 22. Bali RK, Chaudhry K. Maxillofacial surgery and COVID-19, the pandemic!! J Maxillofac Oral Surg 2020; 19(2): 159-161.
• 23. Stinner DJ, Lebrun C, Hsu JR, Jahangir AA, Mir HR. The orthopaedic trauma service and COVID-19: practice considerations to optimize outcomes and limit exposure. J Orthop Trauma 2020; 34(7): 333-340.
• 24. Tan S, Hong C, Saha S, Murphy D, Hui J. Medications in COVID-19 patients: summarizing the current literature from an orthopaedic perspective, Int Orthop 2020; doi: 10.1007/s00264-020-04643-5 (Baskıda).
• 25. Day M. COVID-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ 2020; 368: m1086.
• 26. Armocida B, Formenti B, Ussai S, Palestra F, Missoni E. The Italian health system and the COVID-19 challenge. Lancet Public Health 2020; 5(5): e253.
• 27. Ong SWX, Tan YK, Chia PY, Lee TH, Tek O, Wong MSY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) from a symptomatic patient. JAMA 2020; 323(16): 1610-1612.
• 28. Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative COVID-19 defense: an edivence-based approach for optimization of infection control and operating room management. Anesth Analg 2020; doi: 10.1213/ANE.0000000000004829 (Baskıda).
• 29. Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus disease 19 (COVID-19): implications for clinical dental care. J Endod 2020; 46(5): 584-595.
• 30. Dave M, Seoudi N, Coulthard P. Urgent dental care for patients during the COVID-19 pandemic. Lancet 2020; 395(10232): 1257.
• 31. Zang B, Liu S, Dong Y, Zhang L, Zhong Q, Zou Y, et al. Positive rectal swabs in young patients recovered from coronavirus disease 2019 (COVID-19). J Infect 2020; doi: 10.1016/j.jinf.2020.04.023 (Baskıda).
• 32. T.C. Ministry of Health. The ending of isolation in COVID-19 patients. T.C. Ministry of Health [İnternet yayını]. 2020 [atıf 10.04.2020]. Erişim: https://covid19bilgi.saglik.gov.tr/depo/algoritmalar/COVID19-IzolasyonunSonlandirilmasi-10042020.pdf
• 33. Kamer E, Çolak T. What to do when a patient infected with COVID-19 need an operation: a pre-surgery, peri-surgery and post-surgery guide. Turk J Colorectal Dis 2020; 30(1): 1-8.