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Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 2-5

Effect of coronavirus disease 2019 outbreak on the specialty of maxillofacial surgery

Department of Oral and Maxillofacial Surgery, Santosh Dental College and Hospital, Santosh Deemed to University, Ghaziabad, Uttar Pradesh, India

Date of Web Publication6-Dec-2021

Correspondence Address:
Sanjeev Tomar
Department of Oral and Maxillofacial Surgery, Santosh Dental College and Hospital, Santosh Deemed to University, Ghaziabad, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-1732.331795

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The outbreak of coronavirus disease 2019 (COVID-19) has specific implications for oral and maxillofacial surgeons due to an accrued risk of exposure to the virus throughout surgical procedures involving the aerodigestive tract. Maxillofacial surgical procedures due to direct contact with oral and nasal mucosa that area unit thought of areas of high risk of infection in virtue of viral charge and great risk of exposure to COVID-19. Maxillofacial surgery represents associate example of a specialty that has had to adapt to the present outbreak, due to the subspecialties of medical specialty and medicine. Considering the numerous sociopolitical things in every country, the oral and maxillofacial surgery model was thought of acceptable to evaluate the safety measures taken by the healthcare establishments.

Keywords: Coronavirus, coronavirus disease-2019, health-care provider, maxillofacial surgery, pandemic

How to cite this article:
Tomar S, Lall AB, Singhal M, Mediratta A. Effect of coronavirus disease 2019 outbreak on the specialty of maxillofacial surgery. Santosh Univ J Health Sci 2021;7:2-5

How to cite this URL:
Tomar S, Lall AB, Singhal M, Mediratta A. Effect of coronavirus disease 2019 outbreak on the specialty of maxillofacial surgery. Santosh Univ J Health Sci [serial online] 2021 [cited 2023 May 30];7:2-5. Available from: http://www.sujhs.org/text.asp?2021/7/2/2/331795

  Introduction Top

The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus (COVID-19), rapidly changed our habits.[2] Since December 2019, the news of a respiratory illness focus of unknown cause within the city of Wuhan, Hubei Province, China, had agitated the entire world.[1] All governments were forced to require important counter measure within the face of the speedy unfold of this disease.[2] Two of the main tasks were to cut back the chance of the infection and enhance every country's health-care system resources. In affected regions, hospitals took decisions based on their resources as to which departments will directly deal with COVID-19 patients and those that will not.[1]

The COVID-19 pandemic has specific implications for oral and maxillofacial surgeons as a result of an hyperbolic risk of exposure to the virus throughout surgical procedures involving the aerodigestive tract.[4] The oral and maxillofacial surgery (OMFS) specialty, as different areas of dentistry, suffered important impact in safe observe of its procedures due to direct contact with oral and nasal secretion that are thought of areas of high risk of infection in virtue of viral charge and great possibility of exposure to biological materials proportionated by the generation of aerosol throughout procedures.[2]

The high-risk OMFS face is attributed to the short distance between patient's oral cavity and upper airway to the surgeon's mouth/nose and long length of exposure or contact with the patient throughout surgical procedures. Further, matters are combined by constant contact with the patient's secretions (saliva, mucus, blood, etc.,) throughout completely different phases of diagnosis and disease management process. This is often worsened by the very fact that they risk managing asymptomatic SARS-coronavirus-2 carriers, who have the potential to transmit the sickness considering that the incubation period of the virus is long and unpredictable (0–27 days, mean 6.4 days).[5] Worse still, several patients, who are harboring the virus, might conceal their flu-like symptoms or can be convalescing from the disease.[3]

The nasopharynx and nose area unit represented because the major reservoirs of the virus. The foremost common symptoms at onset are fever, cough, shortness of breath, and fatigue. Alternative typical symptoms are rhinorrhea, sneezing, diarrhea, and abdominal pain. Severe presentations include SARS, with peripheral ground-glass opacities within the lungs on chest imaging.[1]

Maxillofacial surgery represents an example of a specialty that has had to adapt to the pandemic, owing to the subspecialties of oncology and traumatology. OMFS is that the branch that extends from a life savior of trauma and cancer patients to an creative person for sculpturing beautiful faces out of anomalies and giving smiles on each patient's face.[7] Considering the various sociopolitical things in every country, the maxillofacial surgery model was thought of acceptable to measure the protection taken by the health-care institutions.

In times of occurrence of COVID-19, dental procedures in ambulant or hospital atmosphere were restricted to emergency cases (risk of death) such as bleeding, cellulitis, or diffuse bacterial infections, with intra- or extra-oral swelling and fracture of the facial bones, probably compromising the patient's airway; and therefore the urgency care like acute odontogenic pain, pericoronitis, alveolitis, periodontal abscesses, maxillomandibular fracture with painful symptoms or trauma of oral soft tissues, urgent need of dental treatment before a critical medical procedure, biopsies, treatment of tissue necrosis, mucositis, and dental trauma with avulsion or dislocation.[2]

Closed reduction of fractures was given priority over open reduction; self-drilling screws were used for fixation to avoid drilling and saline irrigation. The monopolar electrocautery was usually recommended for the incisions and bipolar for hemostasis, each at low power; extraoral approach was preferred over intraoral.[2]

  Preoperative Protocol Top

The use of prophylactic perioperative hydrogen peroxide or povidone-iodine rinses. Studies have shown that SARS and Middle East respiratory syndrome were extremely liable to Betadine rinse and often assumed that a preprocedural rinse with the agent would possibly decrease the load of coronaviruses in secretion. Povidone-iodine has been shown to have virucidal activity for about 3 h, and recently, it has been suggested to coat the mouth and nasal passages of each the patient and therefore the operational team before the procedure.[3] Intraoral radiographs such as intraoral periapical or occlusal views supposed to stimulate gag reflexes and induce coughing ought to be avoided and substituted by extraoral techniques such as orthopantomogram and cone-beam computed tomography.[3]

Health-care workers should wear protecting gadgets (goggles, face shield, surgical masks, and aprons) whenever they attend patients. The face shields and eyeglasses unit should be disinfected, whereas the mask and aprons area unit modified and disposed of befittingly after attending each patient. For all aerosol-generating procedures (AGPs), powerful suction is employed to get rid of blood and secretions from the site of operation. In the clinics, the operator area should be disinfected when attending each patient, and also the instruments should be sterilized immediately after the procedures. Congestion of patients within the wards should be decreased by shortening length of hospital stay and except when necessary, postop follow-ups should be planned with an extended span of time.[5]

In the cases of unfeasibility of suspending a procedure, a series of protecting measures ought to be followed so as to prevent cross contaminations. The environmental service should offer inputs (water, soap, towel, and bottles with 70% alcohol preparation) for hand hygiene of the patients and attendants. The area wants an improvement reinforcement before and when service, mainly those with larger contact with 70% alcohol solutions and suction instruments with chlorine-based agents. Professionals and collaborators ought to wash their hands with water and soap or 70% alcoholic solution before and when contact with the patient or infected surfaces. The meticulous protection actions such as robe with personal protective equipment (PPEs).[2]

COVID-19 testing (reverse transcription-polymerase chain reaction or Rapid Antigen) is mandatory for patients scheduled for anesthesia on intubation and extubation. The procedures, moreover, as endoscopy, airway suctioning, and tracheostomy, are thought of AGPs. The utilization of high-speed devices such as piezoelectric devices and drills also are thought about AGPs, because of the amount of blood and secretion aerosolized. Therefore, all of these techniques are considered high-risk procedures and may be performed with a high level of protection.[1]

  Intraoperative Protocol Top

Patient intubation ought to be performed by anesthesiologists protected with Filtering Face Piece-2 (FFP2) masks, as suggested by the World Health Organization or the employment of two completely different forms of mask for defense: an FFP2 mask lined by a normal surgical mask and a face shield or goggles, or both. Powered, air purifying respirators ought to be the first protection for medical personnel treating COVID-positive patients and emergency patients who could not be tested. There are limitations to the routine utilization of these respirators in surgery, because of their particular airflow settings, additionally as their price and availability.[1]

The surgical team ought to enter the operation theater after 20 min of intubation with appropriate PPE to attenuate the aerosol-based transmission. Parameters have to be compelled to be obligatory by limitation of professionals concerned in surgery, restriction of workers, and material turnover within the transoperative period. Considering that the contamination risk would be increased by the aerosols of engines, drills, piezoelectric, fluid leak from intubation tubes, to stop viral dispersion to the aspiration of saliva and contaminated secretions, has to be continuous and high power suction.[2] Surgical knife ought to be most most-liked over monopolar cautery while doing open surgery, and continuous suction, irrigation should be minimized; and once achieving hemostasis with bipolar cautery lowest power settings ought to be used. Absorbable sutures ought to be most well liked to attenuate redundant journeys for their removal.[3]

Vascular care is so much of importance, and the use of closed intravenous line system to minimize blood spills is advisable.[7] Australian Society of Anesthesia advised that extubation ought to happen within the operating room and it is counseled that recovery of the patient additionally happen within the operating room if resources enable.[7]

  Postoperative Protocol Top

Patients should be discharge; once it had been determined that hospital stay is not necessary. Early discharge was adopted; patients were discharged early so as to release additional beds. In hospitals, wards and intensive care units (ICU) were divided into two completely different areas: COVID-19 positive and negative. Whenever attainable patients with suspected or confirmed COVID-19 infection must not be treated during a routine follow setting, instead, they must solely be managed in negative pressure theaters or airborne infection isolation rooms AIIRs.[3]

Generally, patients were suggested to take care of a safe distance of 1.5 m. In addition, they were instructed on soap and water handwashing and on hand hygiene using alcohol-based liquids, and surgical masks were provided. A number of visitors were also reduced to one per patient, and access was solely allowed for a visitor sporting PPE. However, in several cases, no visitors were allowed.

  Impact on the Management of Head and Neck Cancer Top

Head-and-neck cancer (HNC)-related surgery had been laid low with delays or cancellations that were influenced partially by the capability of ICU. All the ICU beds had been reserved for COVID patients. Main focus of the health-care system was to manage COVID-19 patients. In the past, the priorities for HNC treatment were survival and cure. Functional deficits and health-related quality of life, though vital, were secondary to treatments that provide the simplest likelihood of a cure. Throughout the pandemic, however, a new concern had arisen among everybody concerned that of the danger from COVID-19. Each cancer patient needs careful clinical follow-up to see for treatment outcome, to assist rehabilitation and identify unmet needs.[6] The COVID-19 crisis had resulted in reduced patient contact and social distancing. Patient follow-up models evolved; however, patients still worth the possibility to discuss their issues and request support and patients inevitably take pleasure in a face-to-face appointment, and therefore the physical examination is extremely reassuring.[6]

  Oral and Maxillofacial Surgery Training Programs Top

All OMFS programs enforced tips to suspend elective and nonurgent surgical procedures and restricted ambulatory clinic visits. OMFS training programs in teaching hospitals; the way to handle emergent procedures, and what measures ought to be taken to ascertain and maintain the security and well-being of our residents and college. The changes in emergency triage, emergency surgical procedures, and therefore the use of PPE to shield health-care personnel (HCP). The American Association of Oral and Maxillofacial Surgeons, the British Association of Oral and Maxillofacial Surgeons, the British Association of Oral Surgeons, and Association of Oral and Maxillofacial Surgeons of India had issued guidelines statements concerning the necessity to attenuate exposure risk to HCP.[4] OMFS training programs within the country to keep up the safety of their providers and patients whereas accommodating for the surge of new infected patients. The management of dental and maxillofacial emergencies, recommendations for PPE throughout clinical care, staffing changes, and resources used for resident didactical surgical training and wellness.

The COVID-19 pandemic challenged residents, faculty, and staff physically, mentally, and emotionally. OMFS residents training programs continued with their core didactical training protocols throughout the COVID-19 pandemic. These consisted of seminars, journal club, and knowledge domain conferences such as trauma and maxillofacial pathology conferences, tumor boards, and craniofacial clinics. Varied self-study activities were additionally utilized by residents throughout this period. The residents used cooperative interinstitutional webinars, textbooks, division didactics, and different lecture series delivered by multiple oral maxillofacial specialty organizations. The digital communication platforms that worked best for conducting OMFS didactical programs were Zoom, Go to Meeting, Microsoft teams, Cisco WebEx, etc., Residents had access to virtual didactical training sessions and self-study resources. It had been necessary to possess some structure to the didactical training and to continue their core activities using virtual classroom technology.[4]

  Conclusion Top

The COVID-19 pandemic has had an excellent impact on maxillofacial surgery all over the world; this nice effort from the maxillofacial surgeons and general medical profession has no precedent in history. The novel coronavirus has modified the health-care system, and also the delivery of maxillofacial surgical procedures was also not an exception. As an oral and maxillofacial surgeon, it is our duty to take care of the protection of ourselves, our residents, our auxiliary employees, and our patients from cross-contamination. Improvement and upgradation of infection control protocol in hospital operating room throughout the Covid-19 pandemic are mandatory.

Confirmed modes of infectious agent transmission are primarily contact with contaminated environmental surfaces and aerosolization. Microorganisms that embody the novel coronavirus do not seem to be visible to eye and thus needs a really stringent approach to tackle. Correct planning before the surgery and its execution as planned is suggested, and also the surgeries to be done by experienced surgeons. We have a tendency to advocate the requirement to reinforce our methods to scale back cross-contamination and transmission of the COVID-19 pandemic. To protect the health-care workers from high-risk infection is significant to making their safety whereas delivering care and to avoid a health-care system collapse.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.[12]

  References Top

Maffia F, Fontanari M, Vellone V, Cascone P, Mercuri LG. Impact of COVID-19 on maxillofacial surgery practice: A worldwide survey. Int J Oral Maxillofac Surg 2020;49:827-35.  Back to cited text no. 1
Reolon LZ, de Oliveira BL, Junior OL. Oral and maxillofacial surgery in front of Covid-19. Open Dent J 2020;14:289-90.  Back to cited text no. 2
Bali RK, Chaudhry K. Maxillofacial surgery and COVID-19, The Pandemic!! J Maxillofac Oral Surg 2020;19:159-61.  Back to cited text no. 3
Brar B, Bayoumy M, Salama A, Henry A, Chigurupati R. A survey assessing the early effects of COVID-19 pandemic on oral and maxillofacial surgery training programs. Oral Surg Oral Med Oral Pathol Oral Radiol 2021;131:27-42.  Back to cited text no. 4
Sohal KS, Simon ENM, Kalyanyama B, Moshy JR. Oral and maxillofacial surgical services amid COVID-19 pandemic: Perspective from Tanzania. Trop Med Health 2020;48:70.  Back to cited text no. 5
Lyons A, Mcdonald C, Kanatas A, Rogers SN. Editorial, early oral cancer management during the COVID-19 period. Br J Oral Maxillofac Surg 2020;58:885-7.  Back to cited text no. 6
Datarkar A, Purohit S, Tayal S, Bhawalkar A. Operating room protocols in OMFS during corona virus (Covid-19) pandemic. J Maxillofac Oral Surg 2020;19:327-31.  Back to cited text no. 7
World Health Organization. Coronavirus (COVID-19) Dashboard.  Back to cited text no. 8
AO CMF International Task Force. AO CMF International Task Force Recommendations on Best Practices for Maxillofacial Procedures during COVID-19 Pandemic. Available from: https://aocmf3.aofoundation.org//media/project/aocmf/aocmf/files/covid19/ao_cmf_covid-19_task_force_guidelines.pdf?.  Back to cited text no. 9
Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. J Craniomaxillofac Surg 2020;48:521-6.  Back to cited text no. 10
Day AT, Sher DJ, Lee RC, Truelson JM, Myers LL, Sumer BD, et al. Head and neck oncology during the COVID-19 pandemic: Reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks. Oral Oncol 2020;105:104684.  Back to cited text no. 11
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 2020;137:159-60.  Back to cited text no. 12


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