4. DISCUSSION
Otolaryngologists and head and neck surgeons are at high risk of contagion by SARS-CoV-2 virus and therefore protective measures and procedures are essential in order to try to maintain safety of healthcare workers during surgery. It has been declared that all the interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory [4]. Long-lasting infections of salivary glands (in particular a history of recurrent salivary abscess) due to obstructive and inflammatory disease are urgent and priority clinical condition needing a therapeutic surgical strategy after an interdisciplinary case-by-case discussion as is currently done for cancer patients. A diagnostic work-up based on initial prescreening with telemedicine to exclude non neoplastic salivary disease and further imaging and COVID-19 screening to follow and prepare patients with suspected salivary gland neoplasms has been recently proposed [5]. On the other hand, the fact that salivary glands are target tissue of SARS-CoV-2 due to the presence of ACE2 receptors and that acute parotitis may be the first clinical manifestation of COVID-19 draws attention on how a surgical approach to salivary glands should be done in particular if a sialendoscopic procedure or a sialendoscopy-assisted surgical approach is planned [4]. We adopted, for the first time, an isolation drape setting to undergo a sialendoscopy-assisted transfacial removal of a parenchymal parotid stone (STAPID) to reduce the risk of contamination during oral sialendoscopy and to separate external surgery from endoral access. The procedure was successful and the presence of isolation drape setting did not interphere with surgery and timing of surgery; moreover, this setting is simple, cost-effective and reproducible. As long as COVID-19 pandemic takes its own course and safety recommendations for evaluation and surgery of the head and neck are developing all efforts have to be done to minimize potential COVID-19 exposure. In this regard, the application of this transparent isolation plastic drap to cover the whole face and the small hole in the mouth to favor the introduction of the sialendoscope into the salivary duct system is part, together with the use of specific Personal Protective Equipment (PPE), of the new strategy to reduce the aerosolization during combined transoral and transcervical salivary surgery.
Author Contributions: MG, AL, and PC: were involved in clinical and surgical management of the patient; AL and JE: reviewed the inherent literature and edited pictures and video; MG: wrote the manuscript; MG and PC: edited the manuscript; MG, AL, JE, ST, LP, PC approved the final version of the manuscript.