Emergency Maxillofacial Procedures for COVID-Positive Patients

With the initial spread of COVID-19 in India and subsequent lockdown, the practice of Oral and Maxillofacial Surgery (OMFS) has taken quite a hit.[1] In the initial days, most of the physicians, clinicians, and surgeons had to modify their way of healthcare delivery and medical procedures. Ensuring the safety (both doctors and patients) and reduction of viral transmission assumed importance. In most of the countries, to meet the acute demand, OMF surgeons were involved in the much-needed surgical tracheostomies.[2] Tracheostomy, in such instances, was performed by maxillofacial surgeons. These relieved the workload pressure from intensive care unit clinicians, whose valuable expertise helped in a different frontier.[3] As such, in COVID-19 patients, all aerosol-generating procedures and the tracheostomies posed a significant risk of viral contamination. There has been much-advocated “5T” approach – Theater setup, Team briefing, Transfer of patient, Tracheostomy procedure, and Team doffing and de-brief – that helps to minimize the risk of transmission of COVID-19.[2] The proper application of barrier techniques and the best evidence approach has minimized the patient to doctor transmission of COVID-19 virus. In few studies, since the viral transmission was nil, high-risk open tracheostomy techniques were practiced by OMFS surgeons.[3] Later, there were viable protocols developed and advocated.[4,5,6,7] There were anecdotal reports of OMFS being infected with COVID-19 due to possible transmission from patients who underwent tracheostomies. However, literature is devoid such any treatment-related transmission. There were several meetings and consensus formed to modify and postulate new treatment norms.[8]

This COVID-19 “Lockdown” period had also highlighted the need for the oral care and OMFS requirement in real time. The emergency requirements of dentists, particularly OMFS, have been reported.[9,10]

The nature of such OMFS requirements vastly differed from the pre-COVID-19 era.[11] Such publications offer a sneak insight into how the OMFS patient reporting differs with the reduced school hours, traffic movements, restricted social interaction, and reduced alcohol availability.[11,12,13,14] These studies offer a unique insight into the way how the OMFS cases present in extraordinary situations. There is no doubt that the number of patients presenting is reduced while the emergency room presentation for dental and oral disorders has increased. These epidemiological studies offer an insight into the complex biopsychosocial constructs of the patients. These could help the dentists, OMFS surgeons, and oral healthcare policymakers to frame suitable policies in such a fashion that future human resources allotment could be revisited. Apart from valuable insight for service and workforce planning, in future, further periods of constraints – human or nature, for example, when releasing staff for redeployment to support other high demand areas such as critical care. OMFS specialist services were still required for fracture, dental injury, and soft tissue management, so a baseline staff would still need to be retained. The exact allotment could be estimated from these base numbers. For policymakers, it helps analyze how the flow of emergency referrals for dental infection has been managed in COVID-19 times – to approach work delegation. COVID-19 has never been a time to produce excuses from research – rather a unique time to provide value-added service to fraternity. It is high time the Indian practitioners plan and execute India's specific data to offer better insights.