The 2019 Coronavirus Panademic challenges the delivery of care for patients with head and neck cancer.  An important aspect of this care has been the evolution of enhanced survivorship services which include surveillance for recurring cancer and prevention of second primaries.  The application of evidence based approaches to identification and management of treatment and tumor related toxicities has embraced the use of validated patient reported outcomes instruments (PROs), health promotion, and care coordination.  In this manuscript we describe how our multidisciplinary team of survivorship providers have accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship.

The novel coronavirus disease 2019 (COVID-19) pandemic continues to have extensive effects on public health as it spreads rapidly across the globe. Head and neck cancer patients are a particularly susceptible population to these effects, and we expect there to be a potential surge in patients presenting with head and neck cancers after the surge in COVID-19. Furthermore, the impact of social distancing measures could result in a shift towards more advanced disease at presentation. With appropriate anticipation, multidisciplinary head and cancer teams could potentially minimize the impact of this surge and plan for strategies to provide optimal care for head and neck cancer patients.

IntroductionThe ongoing worldwide pandemic due to COVID-19 has forced drastic changes on the daily lives of the global population. This is most notable within the healthcare sector. The current paper outlines the response of the head and neck oncologic surgery (HNS) division within our academic otolaryngology department in the state of Alabama.MethodsData with regard to case numbers and types were obtained during the pandemic and compared with time matched data. Our overall approach to managing previously scheduled and new cases, personal protective equipment (PPE) utilization, outpatient clinic, and resident involvement is summarized.DiscussionOur HNS division saw a 55% reduction in surgical volume during the peak of the COVID-19 pandemic. We feel that an early and cohesive strategy to triaging surgical cases, PPE usage, and minimizing exposure of personnel is essential to providing care for HNS patients during this pandemic.

The SARS-CoV-2 pandemic has rapidly transformed healthcare delivery around the globe. Because of the heavy impact of COVID-19 spread, cancer treatments have necessarily been de-prioritized, thus exposing patients to increased risk of morbidity and mortality due to delayed care. In this scenario, cancer specialists need to assess critical oncology patients case by case to carefully balance risk versus benefit in treating tumors and preventing SARS-CoV-2 infection. Here we report early insights into how the management of patients with sinonasal and anterior skull base cancer might be affected by the COVID-19 pandemic. We provide recommendations for preoperative tests, indications for immediate care versus possible delayed treatment, warnings relating to dural resection and intracranial dissection given the potential neurotropism of SARS-CoV2 and practical suggestions for managing cancer care in a period of limited resources. We also postulate some thoughts on the promising role of telemedicine in multidisciplinary case discussions and post-treatment surveillance.

Introduction For the ENT surgeon there are many challenges that show-up in the clinical management of a patient affected by a Head and Neck cancer during COVID-19 pandemic, especially in the postoperative period. Methods During the acute COVID-19 emergency phase in Italy, we analysed the management of a patient affected by a Head and Neck cancer. We reported several clinical data about the hospitalization period, pointing out the difficulties encountered both from clinical and management point of view. Results During pandemic, we admitted 27 oncological patients at our ENT department. Delays in surgical procedures, complications of hospitalizations, need for radiological studies and possible transfer to other hospital ward, due to suspect Sars-CoV-2 infection, were registered. Conclusions The changes in the whole health care system during the COVID-19 pandemic have impacted the management of head and neck cancer patients, generating several clinical challenges for the ENT surgeon.

AIM: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for healthcare practitioners and facilities serving at the frontlines of this pandemic. With regards to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. METHODS: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment versus telehealth assessment during the COVID-19 pandemic. RESULTS: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients.  CONCLUSIONS: The COVID-19 pandemic has required healthcare practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high-risk for severe COVID-19 illness are also higher risk for the development of OPMDs.

Tracheostomy procedures have a high risk of aerosol generation. Airway providers have reflected on ways to mitigate the SARS-CoV-2 transmission risks when approaching a surgical airway. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy time-out applicable to all patients including those suspected of having COVID-19. The aim of the tracheostomy time-out is to reduce preventable errors that may increase the risk of transmission of SARS-CoV-2.

Coronavirus disease 2019 has undoubtedly impacted the healthcare system while causing lasting and profound implications for medical education. Senior medical students seeking exposure to the field of otolaryngology now find themselves in the challenging position of obtaining the experiences to make an informed decision on a future specialty. Virtual electives using comprehensive online material, discussion, and videos as well as the advent of telemedicine may be potential solutions to increase exposure to otolaryngology. While incorporating opportunities for authentic patient interactions is still a challenge, it is crucial that the academic otolaryngology community prioritize seeking solutions for interested medical students

Background:  The COVID-19 pandemic has raised concern of transmission of infectious organisms through aerosols formation in endonasal and transoral surgery.Methods: Retrospective review. We introduce the Negative-Pressure Otolaryngology Viral Isolation Drape (NOVID) system to reduce the risk of aerosol. NOVID consists of a plastic drape suspended above the patient’s head and surgical field with a smoke evacuator suction placed inside the chamber.Results:  Four patients underwent endonasal (4) and endo-oral surgery (1). Fluorescein was applied to the surgical field. Black light examination of fluorescein treated operative fields revealed minimal contamination distant to the surgical field. In two prolonged cases with high-speed drilling, droplets were identified under the barrier and on the tip of the smoke evacuator. Instruments and cottonoids appeared to be a greater contributor to field contamination.Conclusions: Negative-pressure aspiration of air under a chamber barrier which appears to successfully keep aerosol and droplet contamination to a minimum.

Background: Otolaryngologists represent a subset of healthcare workers uniquely vulnerable to COVID-19 transmission. Given the segmentation of extant guidelines concerning precautions and protective equipment for SARS-CoV2, we aimed to provide consolidated recommendations regarding appropriate personal protective equipment (PPE) in head neck surgery during the COVID-19 era.Methods: Guidelines published by international and United States governing bodies were reviewed in conjunction with published literature concerning COVID-19 transmission risk, testing, and PPE, to compile situation-specific recommendations for head and neck providers managing COVID-19 patients.Results: High-quality data regarding the aerosolization potential of head and neck instrumentation and appropriate PPE during head and neck surgeries are lacking. However, extrapolation of recommendations by governing bodies suggest strongly that head and neck mucosal instrumentation warrants strict adherence to airborne-level precautions.Conclusion: We present a series of situation-specific recommendations for PPE use and other procedural precautions for otolaryngology providers to consider in the COVID-19 era.

Background: The United States now has the highest death toll due to COVID-19. Many otolaryngology procedures, including laryngoscopy, bronchoscopy, and esophagoscopy, place otolaryngologists at increased risk of coronavirus transmission due to close contact with respiratory droplets and aerosolization from the procedure. The aim of this paper is to provide an overview of guidelines on how to perform these procedures during the coronavirus pandemic. Methods: Literature review was performed. Articles citing laryngoscopy, bronchoscopy, esophagoscopy use in regards to COVID-19 were included.Results: Laryngoscopy, bronchoscopy, and esophagoscopy are all used in both emergent and elective situations. Understanding the risk stratification of cases and the varied necessity of personal protective equipment is important in protecting patients and healthcare workers.  Conclusions: Summary guidelines based on the literature available at this time is presented in order to decrease transmission of the virus and protect those involved.

With the arrival of the coronavirus disease (SARS-CoV-2) in the U.S., care practice paradigms have drastically changed. Data from China suggests the new virus poses additional risks as case fatality of patients with cancer was higher at 5.6% compared to 2.3% of the general population. There are three proposed major strategies to address care for patients with cancer in this SARS-CoV-2 pandemic with postponing treatment for those with stable cancer, increasing personal protection provisions for cancer patients, and increasing monitoring if a patient becomes infected with SARS-CoV-2.  In this present commentary, we discuss the unique mental health challenges and burdens of head and neck cancer (HNC) patients in the times of the SARS-CoV-2 pandemic and approaches to mitigate these stressors through telemedicine to reduce future burdens to the patient and the health care system.