Re: Toward a consensus view in the management of acute facial injuries during the COVID-19 pandemic.

Abstract

We commend Holmes et al for their recent article regarding the management of facial trauma during the COVID-19 pandemic.1Holmes S, Bhatti N, Bhandari R, et al. Toward a consensus view in the management of acute facial injuries during the Covid-19 pandemic. Br J Oral Maxillofac Surg available from URL: https://www.bjoms.com/article/S0266-4356(20)30128-5/abstract (last accessed 1 May 2020).Google Scholar They addressed the issue of teamwork among medical professionals to deliver safe care to patients. In this letter, we aim to highlight how public institutions and private practitioners can collaborate to manage patients with facial injuries during the pandemic. Due to the high infectivity of SARS-CoV-2 and the number of asymptomatic carriers who are acting as transmitters, most governments have enacted containment measures to limit the spread of this disease. These measures have substantially modified our daily clinical practice in oral and maxillofacial surgery (OMFS) and they require us to focus on patients in medical and surgical emergency situations. Furthermore, human and technical resources have been reallocated to intensive care (ICU) and medical units treating patients with COVID-19, thereby changing current hospital practices and reducing resources for more commonplace operating theatre activities (described as scenario B, by Holmes et al).1Holmes S, Bhatti N, Bhandari R, et al. Toward a consensus view in the management of acute facial injuries during the Covid-19 pandemic. Br J Oral Maxillofac Surg available from URL: https://www.bjoms.com/article/S0266-4356(20)30128-5/abstract (last accessed 1 May 2020).Google Scholar Emergencies that involve life-threatening conditions (such as haemorrhage or obstruction of the upper respiratory tract) need to be treated without delay in reference medical centres, irrespective of their public or private status.2Yang Y. Soh H.Y. Cai Z.G. et al.Experience of diagnosing and managing patients in oral maxillofacial surgery during the prevention and control period of the new coronavirus pneumonia.Chin J Dent Res. 2020; 23: 57-62PubMed Google Scholar Facial injuries can be managed differently, depending on their severity. While life-threatening cases and patients with multiple injuries require multidisciplinary management in a trauma centre,3Choi J. Lorenz H.P. Spain D.A. Review of facial trauma management.J Trauma Acute Care Surg. 2020; 88: e124-30Crossref PubMed Scopus (10) Google Scholar others can be managed by case-by-case assessment of the complexity of the fractures, and possible referral to a private practitioner. We devised an algorithm based on the need for preoperative or postoperative monitoring in ICU (Fig. 1). We have considered that most closed fractures (such as those in groups 2 and 3 according to Holmes et al)1Holmes S, Bhatti N, Bhandari R, et al. Toward a consensus view in the management of acute facial injuries during the Covid-19 pandemic. Br J Oral Maxillofac Surg available from URL: https://www.bjoms.com/article/S0266-4356(20)30128-5/abstract (last accessed 1 May 2020).Google Scholar can be managed by private practitioners if the patients do not require monitoring in ICU. We have also devised a degraded procedure involving the use of tracheostomy for complex situations with no possibility of extubation. In all cases, surgical practices should be adapted to take into account new priorities stemming from the COVID-19 pandemic: operations should be shortened to reduce anaesthetic drug use, aerosolisation should be avoided whenever possible, and all surgeons and staff should wear full protective equipment to limit transmission of the virus, as every patient is potentially an asymptomatic carrier of SARS-CoV-2.4Zimmermann M. Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic.J Craniomaxillofac Surg. 2020; https://doi.org/10.1016/j.jcms.2020.03.011Crossref PubMed Scopus (98) Google Scholar, 5French Society of Stomatology Maxillo-Facial Surgery Oral Surgery (SFSCMFCO) Practitioners specialized in oral health and coronavirus disease 2019: Professional guidelines from the French society of stomatology, maxillofacial surgery and oral surgery, to form a common front against the infectious risk.J Stomatol Oral Maxillofac Surg. 2020; 121: 155-158Crossref PubMed Scopus (24) Google Scholar We are aware that this strategy cannot constitute a guideline, since it reflects only the situation in the sixth-largest French city, which comprises one public university hospital and a large number of private OMFS. However, it does reflect the importance of the partnership between public and private professionals in providing safe and quality care to our patients. Not required. We have no conflicts of interest.