Customised face mask: Solution to facial nerve blocks in COVID-19.

Abstract

Sir, During coronavirus disease (COVID)-19 times, it is important to cover a patient's face with a protective mask. However, managing patients with chronic pain can become extremely challenging especially in cases of uncontrolled cranial neuralgias that may require nerve blocks on the face. Trigeminal nerve has been approached indirectly through injection in the pterygopalatine fossa in trauma patients.[1] Since the traditional mask covers most of the area of the face, it is not possible to perform these blocks with safety. Concurrently, the chances of acquiring COVID infection through aerosols become multifold if the patient's mask is removed during the procedure. We tried to tackle this encountered problem by customising the face masks for such procedures. This customised face mask has a smaller footprint covering only the nasal and oral apertures thus leaving ample space for head and neck nerve blocks to be performed. A smaller dimensioned cloth was cut and sewn. A single elastic band was attached from the edges of the mask, which wraps around the head area, combined with a flexible strip at the nasal end to ensure a proper fit and seal of the mask [Figures Figure 1a, b and 2a, b]. A similar mask is also being tried with success by dermatologists for laser hair removal of the facial region.[2] This mask has been used for performing infra-orbital, mental, mandibular, maxillary and glossopharyngeal nerve blocks in more than 10 patients, presenting to our OPD clinic. This mask provides great comfort and safety for both patients and doctors during this pandemic.Figure 1: (a) Inability to perform facial blocks with normal mask. (b) Customised face mask with wider work fieldFigure 2: (a) Front view of customised face mask with landmarks. (b) Side view of customised face mask.Financial support and sponsorship RM Aesthetics provided material and logistics support. Conflicts of interest There are no conflicts of interest. Acknowledgements We acknowledge Mrs. Manjeet Kaur for sewing and customising mask for us.