NEW NORMAL เมื่อต้องผ่าตัดขากรรไกรในช่วงโรคระบาด...ควรทำยังไงดี

Jaw surgery, or oral maxillofacial surgery, is mostly a type of non-urgent surgery that can be scheduled. During the outbreak of the coronavirus disease 2019 (COVID-19), it inevitably affects jaw bone surgeries. In this article, I will discuss the preparation methods for patients who need jaw bone surgery during the COVID-19 era. I refer to the information from the “Guidelines for Procedures and Surgeries during the Coronavirus Disease 2019 (COVID-19) Outbreak” announced by the Department of Medical Services on May 7, 2020.
<h2>Understanding Elective Surgery Cases</h2>
During the COVID-19 outbreak, with limited medical resources and safety concerns for healthcare personnel, it is recommended to adjust the proportion of surgical services by considering
<ul>
<li>The urgency of the disease, non-urgent conditions that can be scheduled for surgery (Elective cases)</li>
<li>The condition of the patient undergoing surgery</li>
<li>The use of hospital resources</li>
</ul>
For the safety of healthcare personnel in selecting elective surgeries, all medical teams must prioritize and participate in screening every patient for the risk of COVID-19 infection as part of the medical evaluation before surgery as follows:
<ul>
<li>Screening by history taking (social risk factor, physical/medical risk factor) according to clinical practice guidelines for diagnosis, treatment, and prevention of COVID-19 infection in hospitals, along with symptom and sign assessment before scheduling surgery, detailed as follows:</li>
</ul>
History Taking
<ul>
<li>History of travel to or residence in areas with ongoing COVID-19 outbreaks</li>
<li>History of family members diagnosed with COVID-19</li>
<li>Contact with COVID-19 patients or respiratory secretions without appropriate personal protective equipment</li>
<li>Occupation related to tourists, crowded places, or contact with many people</li>
<li>History of visiting community places or crowded areas such as markets, shopping malls, healthcare facilities, or public transportation</li>
<li>Healthcare personnel with potential close contact or exposure to COVID-19 patients</li>
<li style="list-style-type: none;">
<ul>
<li style="list-style-type: none;"></li>
</ul>
</li>
</ul>
Symptoms &amp; Signs
<ul>
<li>Cough</li>
<li>Sore throat</li>
<li>Fever with temperature of 37.5°C or higher</li>
<li>Runny nose</li>
<li>Loss of smell</li>
<li>Headache</li>
<li>Muscle pain</li>
<li>Shortness of breath / rapid breathing</li>
<li style="list-style-type: none;">
<ul>
<li style="list-style-type: none;"></li>
</ul>
</li>
</ul>
If a patient is suspected or at risk of COVID-19 infection based on the above criteria, elective surgery should be postponed. The patient should monitor symptoms at home for at least 1 month before reconsidering surgery preparation or referral to a clinic for COVID-19 diagnostic testing.
<ol>
<li>For medical evaluation on the day of surgery, especially for patients undergoing general anesthesia or potential general anesthesia, there should be a system for anesthesiologist or internist consultation (according to each hospital’s policy) to minimize hospital visits and length of stay.</li>
<li>It is recommended to perform virology laboratory screening by nasopharyngeal and throat swabs, tested by real-time reverse transcriptase polymerase chain reaction (RT-PCR) or Nucleic Acid Amplification Test (NAAT).</li>
<li style="list-style-type: none;"></li>
</ol>
If the virology test is positive and the patient is diagnosed as an asymptomatic COVID patient, treatment should follow the Ministry of Public Health guidelines, and elective surgery should be postponed until recovery for at least 1 month from the test date before reconsidering surgery preparation without the need for repeat viral testing.
<ol>
<li>If the virology test is negative, surgery should be performed promptly within 7 days after testing to reduce the risk of infection during this period. Patients should be strictly advised on preoperative behavior, including maintaining social distancing, avoiding risky behaviors, not being close to people with cold symptoms, avoiding crowded places, and refraining from meeting relatives or others, especially those from other areas.</li>
<li>On the day of surgery, the medical team should re-screen the patient by physical examination, risk history, and respiratory infection symptoms to ensure the patient is free from COVID-19 infection before surgery. No additional viral testing is required.</li>
</ol>
These are the recommendations for patients and medical teams in hospitals to prepare patients for jaw bone surgery in the NEW NORMAL era. In the next article, I will discuss how postoperative care for jaw bone surgery has changed.
&nbsp;
Dr. Vetas Sakdechyon
Oral and Maxillofacial Surgery Specialist
Dental Center, Phyathai 2 Hospital

Because during the pandemic, oral procedures may increase the risk of infection, here are guidelines for patients and the medical and nursing team.

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NEW NORMAL When undergoing jaw surgery during a pandemic... what should be done?

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