RESULTS
Fifteen patients with no clinical evidence of COVID-19 underwent
operations for head and neck cancer: 3 patients with metastatic squamous
cell carcinoma of unknown primary underwent examination under
anaesthesia, transoral robotic (TORS) tonsillectomy and tongue base
mucosectomy and modified radical neck dissection; 2 patients underwent
radical tonsillectomy, modified radical neck dissection, free
anterolateral thigh flap reconstruction and tracheostomy for tonsillar
carcinoma; 2 patients with carcinoma of the tongue underwent glossectomy
and selective neck dissection followed by free anterolateral thigh flap
reconstruction and tracheostomy; 1 patient underwent total laryngectomy
for recurrent carcinoma of larynx; 3 patients with recurrent
pharyngo-esophageal carcinoma underwent total laryngectomy (n=3),
circumferential pharyngectomy (n=3) and cervico-esophagectomy after
manubrial resection (n=1), followed by reconstruction with free jejunal
flap (n=3); 3 patients with recurrent nasopharyngeal carcinoma underwent
tracheostomy followed by maxillary swing nasopharyngectomy, 1 patient
required selective neck dissection and free vastus lateralis flap
coverage of exposed internal carotid artery; 1 patient with carcinoma of
maxilla underwent tracheostomy, total maxillectomy, selective neck
dissection and free anterolateral thigh flap reconstruction. (Table 1)
There were a total of 45 procedures of which 26 involved mucosa along
the upper aerodigestive tract. There were 12 procedures which involved
manipulation of the airway including temporary tracheostomy (n=8) and
laryngectomy (n=4). Operating surgeon and scrub nurse were involved in
all surgical procedures (n=45). First assistant was involved in all but
tracheostomy operations (n=37). Second assistant was not involved in
TORS, tracheostomy and free flap harvest procedures (n=25). Overall
droplet size ranged from 0.3mm to 3.0 mm. Percentage of procedures with
droplet contamination was 57.8% for the operating surgeon (n=26),
59.5% for the first assistant (n=22) and 8.0% for the second assistant
(n=2). No droplets were noted on all face shields of the scrub nurse
(n=45).
Average droplet count was highest for procedures involving osteotomies
such as maxillectomy (n=1), maxillary swing (n=3) and manubrial
resection (n=1). Droplet spread was more widespread (zones 2-12) for
maxillectomy procedures (n=4), involving face shields of the operating,
first and second assistant surgeons.
Non-osteotomy surgical procedures involving mucosa of the nasopharynx
(n=3), oropharynx (n=5), oral cavity (n=2), laryngo-pharyngeal apparatus
(n=4), and trachea (n=8) yielded minimal droplet count on face shields
of the operating surgeon and first assistant, affecting zones 6-11 which
were over the lower half of the face. There was one droplet splash at
zone 2 of the first assistant during nasopharyngectomy, corresponding to
upper half of the face. No droplet splash was noted on the second
assistant’s face shield. No droplet splash was documented on face
shields of the operating surgeon and first assistant for TORS.
Average droplet count from non-mucosal, non-osteotomy related surgical
procedures such as neck dissection (n=9) and free flap harvest (n=9) was
minimal on both the operating surgeon’s and first assistant’s face
shields, mainly affecting zones 6, 7, 10 and 11 which were concentrated
on the lower half of the face. One drop was noted in zone 6 of the
second assistant’s face shield during modified radical neck dissection.