Craniomaxillofacial Trauma and Urgent Otolaryngologic Conditions
As emergency departments across the United States continue to serve patients with urgent medical needs, individuals who present with facial trauma, uncontrolled epistaxis, abscesses, and other conditions will require urgent management by otolaryngologists, including bedside procedures or operative intervention. Given our current understanding of COVID-19, the nasopharynx and nasal cavity harbor the highest viral load and protective precautions must be enforced with addressing injuries or urgent conditions in this location. We recommend the use of enhanced PPE for providers performing bedside procedures on patients with unknown, suspected, or positive COVID-19 status including repair of facial lacerations, management of animal bite wounds, control of epistaxis, peritonsillar abscess drainage, or any other condition requiring invasive examination or instrumentation of the oral cavity, oropharynx, nasal cavity, or nasopharynx. Enhanced PPE is indicated due to the increased risk aerosolization of saliva and nasal secretions in this setting. Patients presenting with operative facial fractures (e.g. orbital, mandibular, nasal, Le Fort pattern fractures, etc.), require preoperative COVID-19 diagnostic testing 48 hours prior to proceeding with elective surgical intervention with the patient kept in strict quarantine pending test results. In scenarios warranting emergent surgical intervention (e.g. rectus muscle entrapment, retrobulbar hemorrhage, flail mandible fractures, etc.) all operating room staff must utilize enhanced PPE as the COVID-19 status for these patients is unknown and should be presumed positive.