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Maxillofacial surgery beyond the perfect storm of COVID-19
Maxillofacial Plastic and Reconstructive Surgery volume 43, Article number: 7 (2021)
After the first report of SARS-CoV-2 virus infection in December 2019, the outbreak of acute respiratory syndrome, coronavirus disease 2019 (COVID-19) affected national and global health care system and economy. The World Health Organization (WHO) declared the COVID-19 outbreak as a global pandemic on March 2020 . The respiratory droplets of COVID-19 patients can be a direct or indirect source of person-to-person transmission. In dental office, there are a lot of face-to-face communications for treatments and the possibility of aerosol formation that contain patients’ saliva, blood, and other oral fluids. The SARS-CoV-2 can be persisted on the surface of instruments of days and in aerosols for hours . Moreover, COVID-19-positive patients without signs or symptoms of COVID-19 also can transmit the disease, the exact scientific data on SARS-CoV-2 viral transmission during dental procedure . However, aerosols generated from dental procedures in COVID-19 patients also can contain SARS-CoV-2 virus and potentially transmit the virus to the practitioners and other patients . It is the standard recommendation to wear proper personal protective equipment (PPE) including a surgical mask, face shield, protective gown, cap, and gloves during dental procedure contacting or splashing the body fluid or blood [5, 6]. Especially for the aerosol-generating procedures, respiratory protection with N95 or FFP2 respirator is recommended because it can filter the droplet and protect exhalation [3, 5]. Therefore, WHO and most of the other countries recommended to delay non-urgent oral health care. Urgent or emergency care can be provided in patients with infection, swelling, bleeding, trauma, or severe pain that cannot be controlled with routine analgesics [1, 3]. Therefore, maxillofacial surgeries such as orthognathic surgery, cleft, or reconstructive surgeries were not a primary target of treatment during the COVID-19 outbreak period. The COVID-19 pandemic completely changed the pattern of the treatment for elective surgery cases. During the severe outbreak period of COVID-19, from March to April 2020 in Korea, University hospitals in the author’s city were fully occupied with critical care for severe COVID-19 patients. Therefore, it was difficult to carry out maxillofacial surgery because of the insufficiency in assisting nurses at the operation room. In the future, COVID-19 would be controlled by a variety of efforts and development of vaccination.
The current question is “how can we perform maxillofacial surgery in the post-pandemic era?” It is not likely to return to the pre-pandemic health care environment because we do not have enough knowledge on the safety of a routine dental treatment or elective surgery on the aerosol-mediated transmission of COVID-19. It is interesting that even with the fundamental risk of transmission of COVID-19 via dental procedures, the reported case of transmission is not frequent. According to a survey on 2195 US dentists, 355 were tested for SARS-CoV-2 and 20 dentists were confirmed or probable COVID-19 infection. In most of the COVID-positive dentists (75%, n = 15), a probable source of infection was not identified and 5 patients were related with community transmission . From an Italian report, the transmission between the patient and dental practitioners or assistants was not found after single or multiple dental consultations after the lockdown of a city . A recent case report showed that even for a confirmed SARS-CoV-2-positive patient, there was no viral SARS-CoV-2 RNA was detected in oral mucosa via PCR assay . Based on these reports, more prospective studies need to be performed to clarify the real risk of transmission of COVID-19 under the current protocol for disease prevention.
In the author’s hospital, from March 2020, every patients were tested for SARS-CoV-2 before admission for surgery. Emergency patients who could not perform a COVID-19 test before surgery were regarded as potential COVID-19 patients. Therefore, the elective oral and maxillofacial surgery could be selectively performed under general anesthesia. Now we are returning to a new normal. A review of current COVID-19 prevention strategies and cases of clinic-based transmission of COVID-19 need to be more thoroughly investigated.
WHO. Director-General’s opening remarks at the media briefing on COVID-19 - 21 December 2020, https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19%2D%2D-21-december-2020.
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B (2020) Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 12:9
CDC, Guidance for Dental Settings; Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. https://www.cdcgov/coronavirus/2019-ncov/hcp/dental-settingshtml 2020; Updated Dec. 4, 2020.
Fallahi HR, Keyhan SO, Zandian D, Kim SG, Cheshmi B (2020, 2020) Being a front-line dentist during the Covid-19 pandemic: a literature review. Maxillofac. Plast Reconstr Surg 42:12
WHO. Considerations for the provision of essential oral health services in the context of COVID-19. https://www.whoint/health-topics/oral-health 2020.
Keyhan SO, Fallahi HR, Motamedi A et al (2020) Reopening of dental clinics during SARS-CoV-2 pandemic: an evidence-based review of literature for clinical interventions. Maxillofac Plast Reconstr Surg 42:25
Estrich CG, Mikkelsen M, Morrissey R et al (2020) Estimating COVID-19 prevalence and infection control practices among US dentists. J Am Dent Assoc 151:815–824
Farronato M, Tadakamadla SK, Ali Quadri MF et al (2020) A call for action to safely deliver oral health care during and post COVID-19 pandemic. Int J Environ Res Public Health 17
Troeltzsch M, Berndt R, Troeltzsch M (2021) Is the oral cavity a reservoir for prolonged SARS-CoV-2 shedding? Med Hypotheses 146:110419
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Kwon, TG. Maxillofacial surgery beyond the perfect storm of COVID-19. Maxillofac Plast Reconstr Surg 43, 7 (2021). https://doi.org/10.1186/s40902-021-00293-8