ABSTRACT
The COVID-19 pandemic has raised concern of viral transmission during otolaryngological procedures by means of droplets/saliva. The use of PPE and isolation settings are mandatory during surgery. This paper describes the development of the STAPID setting to reduce salivary spread during a sialendoscopy-assisted transfacial removal of a parotid stone.
1. INTRODUCTION
Severe-Acute-Respiratory-Syndrome Coronavirus 2 (SARS-CoV-2), a novel highly-transmissible respiratory coronavirus, was responsible of coronavirus disease 2019 (COVID-19) since December 2019. On March 11, 2020 the World Health Organization (WHO) declared COVID- worldwide pandemic. Person-to-person transmission occurs primarily through droplets spread by coughing or sneezing from an infected individual or via direct contact. Recently, the virus has also been detected in saliva samples, thus making saliva a potential transmission route for COVID-19; in fact, To et al. tested SARS-CoV- saliva samples from 12 patients: all but one were positive with a decreasing viral load trend [1]. A SARS-Cov-2 tropism for the epithelial salivary ducts cells through angiotensin-converting enzyme 2 (ACE2) receptors was described in rhesus macaques [1]. This suggests the possibility of SARS-CoV-2 salivary infection, although its detection in saliva may be partially related to the contribution, in this milieu , of secretions from the nasopharynx or the lower airways. It has been recently hypothesized that the infection of SARS-CoV-2 could favour acute sialadenitis and, after the acute phase, chronic sialadenitis as a consequence of fibrosis repairment [2]. It is not a casualty that we recently described a SARS-CoV-2 positive patient whose first clinical manifestation was an acute non-suppurative parotitis [3]. During this pandemic, patients continue to come with urgent head and neck pathologies requiring surgery. A general consensus exists on high risks of contagion by SARS-CoV-2 during otolaryngological procedures that may determine an aerosolisation with nosocomial amplification of the infection. Moreover, procedures requiring close contact with saliva, such as surgical procedures for salivary gland disease with a transoral and/or combined oral and external approach [4], may determine the risk of spreading the infection by means of salivary contamination. For those reasons, the use of particular Personal Protective Equipment (PPE) and isolation settings are mandatory to protect health-workers, especially otolaryngologists. We here describe our experience developing the STAPID (Sialendoscopy-assisted Transfacial Approach to Parotid gland and duct Isolation Drape setting) to reduce salivary spread in and around the surgical field during a sialendoscopy-assisted transfacial removal of a parotid stone causing recurrent episodes of gland abscess.