New Normal for Oral Maxillofacial Surgery
Oral maxillofacial surgery is considered as an elective case and can be scheduled in advance. During COVID-19 outbreak, there is an unavoidable effect on oral maxillofacial surgery. In this article, preparing the patient who is required to undergo oral maxillofacial surgery during COVID-19 outbreak will be discussed. Preparation information is based on clinical guideline for surgical procedure during the Novel Coronavirus (COVID-19) epidemic which is announced by Department of Medical Services on 7th May 2020.
Elective Case Surgery
Due to limited medical resources and safety of medical personnel during COVID-19 pandemic, the surgery or operation should be prioritized by considering the following issues:
1. Urgent case or elective case
2. Patient condition prior to undergoing surgery
3. Medical resources of the hospital
For the safety of medical personnel in performing elective case, healthcare team member should focus on screening every patient who may be at risk of developing COVID-19. The screening should be one of the assessment criteria prior to the surgery.
(1) History taking (social risk factor, physical/medical risk factor) according to clinical guideline of diagnosis, care and prevention of COVID-19 infection in the hospital which should be done together with evaluation of symptoms before surgery appointment.
History taking (Table 1)
1. Travelled to / from or living in the ongoing affected areas.
2. Have a member of family confirmed with COVID-19.
3. Have a direct contact with COVID-19 patients or contact the respiratory tract secretions without wearing personal protective equipment (PPE).
4. Work in the tourism industry, in the crowded area or directly work with a large number of people.
5. Visit crowded places such as flea market, shopping mall, and hospital and use public transportation.’
6. Medical staff that have direct contact with COVID-19 patients
Symptoms and Sign
- Sore throat
- Fever of 37.5℃ or above
- Runny nose
- Loss of smell
- Aches and pains
- Shortness of breath
If the patient is suspected of being infected with COVID-19 according to table 1, elective surgery should be postponed and self-observation at home at least one month is recommended for surgery planning afterwards. Alternatively, the patient will be referred to ARI clinic for COVID-19 test.
(2) For patients who are scheduled to have surgery appointment especially patients who will undergo surgical procedure under general anesthesia or potential general anesthesia, they should be carefully evaluated by anesthesiologist or internal medicine doctor (according to the policy of the hospital board of committees). In addition, they should spend least time at the hospital as well as visit the hospital as less as possible.
(3) Screening test by nasopharyngeal and throat swab is recommended which the sample will be sent for the laboratory test using the method of realtime reverse transriptase polymerase chain reaction (rRT-PCR) or Nucleic Acid Amplifcation Test (NAAT). If the result is positive and the patient is diagnosed as Asymptomatic COVID patient, the patient should receive the treatment according to guideline of Ministry of Public Health. As a result, elective surgery should be postponed at least 1 month from the test date until the patient recovers. The surgery can be later set and there is no need to repeat the COVID-19 test.
(4) If the result shows negative finding, the surgery should be performed within 7 days after the result is available to reduce the risk of infection. While waiting for the surgery, the patient should strictly follow the guideline to prevent the infection such as maintaining a distance from others especially those who have respiratory symptoms, avoiding visiting crowded places or visiting cousins or others who travel from another area.
(5) On the day of the surgery, both the physician and nurse should screen the patient by physical examination and history-taking to recheck for any signs or symptoms of respiratory illness prior to the surgery. This examination is performed to ensure that the patient is not infected with COVID-19. The COVID-19 test is not required.
These are the guidelines for patient and medical staff of the hospital in preparation of oral maxillofacial surgery as a New Normal practice. In the next article, we will explain post-operative of oral maxillofacial surgery if there are any changes.
Dentist, Phyathai 2 Hospital
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