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.