A novel β-coronavirus (2019-nCOV), identified in Wuhan City in late December 2019, is generating a rapid and tragic health emergency in Italy due to the need to provide assistance to an uncontrollable number of infected patients and, at the same time, treat all the non-deferrable oncological and traumatic maxillofacial conditions. This article summarises the clinical and surgical experience of Maxillofacial Surgery Unit of “Magna Graecia” University (Catanzaro -Italy) during the COVID-19 pandemic and would like to provide a number of recommendations that should facilitate the scheduling process of surgical activities during the COVID-19 pandemic and reduce the risk of infection among healthcare professionals.
The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, Hubei province, China, and rapidly spreading to other provinces of China and 190 other countries, was declared a global pandemic by WHO on March 9, 2020, becoming a “public health emergency of international concern”. Patients who are COVID-19 positive are the main source of infection, the asymptomatic ones are extremely contagious, with a strong infectivity in the incubation period ranging from 1 to 14 days. The person-to- person transmission routes of 2019-nCoV included direct transmission, such as coughing, sneezing, droplet inhalation, and contact transmission, such as contact with oral, nasal, and eye mucous membranes. The faecal-oral route remains to be determined. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. The risk of infection during the diagnosis and treatment of oral diseases was also quickly assessed, suspending non-urgent outpatient oral treatments and maintaining the main emergencies of the oromaxillofacial district represented by trauma, malignant neoplasms, and infections, which require timely treatment.
The maxillofacial surgeon belongs to a specific category of healthcare worker as they must inevitably come into contact with the oral cavity, first airways and with patient’s secretions (such as saliva, mucus, blood) during the diagnosis and treatment process, puts them in a situation of high risk of contracting the infection and becoming, in turn, a source of contagion.
There is a high viral burden in the nose and the aerosolised form of the virus can persist for up to 3 hours in the air and 48 to 72 hours on select surfaces.
The aim of this work is to present a protocol to standardise facial pathology triage and precautions to impose to appropriately care for patients while minimising the risk to surgeons. This protocol has been used on patients successfully treated at the Maxillofacial Surgery Unit of “Magna Graecia” University of Catanzaro (UNICZ) from February 29 to April 16, 2020 for traumatic and oncological pathology that cannot be postponed, according to the directives given by the Minister of Health of Italy on March 9, 2020.
Material and methods
From February 29 to April 16, 2020 the medical schedules of all patients hospitalised in the Maxillofacial Unit of “Magna Graecia” University of Catanzaro have been collected. During this month, 33 patients were treated. Patients age, sex, and pathology were taken into consideration; also all have undergone two triages, one by telephone and one at the time of admission.
Demographic characteristics and pathology of the study population
A total of 33 patients were included in this study; 24 were males and 9 females with a male to female ratio of 2.6:1.
The range age was of 20 to 80 with a mean age of 60.53 years. Of all patients, 13 were resident in the province of Catanzaro and 20 were from other provinces of Calabria ( Table 1 ).
|Male||60.53||Province of Catanzaro 15|
|Other provinces 5|
|Female||65.11||Province of Catanzaro 5|
|Other provinces 4|
During this period of COVID-19 emergency, the main pathologies were traumas and non-differentiable oncological diseases, in particular 20 were fractures and 13 tumours. Among injured patients, the mandible was the most frequently involved bone (7 patients) followed by orbital-maxillo-zygomatic complex -COMZ- (5 patients), orbital walls (4 patients), nasal bones -OPN- (3 patients), naso-orbital-ethmoid complex -NOE- (1 patient). Of these, only 10 have been treated under general anaesthesia with internal rigid fixation through plates and screws (7 patients with mandibular fracture, 4 with orbital wall fractures, 3 with COMZ fracture and 1 with NOE), the remaining 5 were returned to the outpatient clinic because they suffered from compound fractures that did not require surgical treatment.
Of 13 cancer patients, 7 have been treated in general anaesthesia, for oral squamous cell carcinoma, 5 for squamous skin cancer and 1 for submandibular gland mucoepidermoid carcinoma ( Table 2 ).
|Pathology||Type||Surgery in general anesthesia||No Surgery||Hospitalisation time|
|Trauma: 20||Mandible: 7||Mandible: 7||5 days|
|Orbital walls:4||Orbital walls: 4||5 days|
|COMZ: 5||COMZ: 3||COMZ: 2||5 days|
|NOE: 1||NOE: 1||5 days|
|OPN: 3||OPN: 3|
|Neoplasm: 13||Skin, head and neck carcinoma: 5||Skin, head and neck carcinoma: 5||5–7 days|
|Oral carcinoma: 7||Oral carcinoma: 7||7 days|
|Submandibular carcinoma: 1||Submandibular carcinoma: 1||5 days|