Guidelines for oral, pharyngeal and laryngopharyngeal surgery during COVID-19 pandemic


  • Parvez Husain Department of ENT, Expert ENT and Diagnostic Centre, Barabanki, Uttar Pradesh, India
  • Benazeer Husain Department of ENT, Expert ENT and Diagnostic Centre, Barabanki, Uttar Pradesh, India
  • Shaheen Khalil Ahmed Department of ENT, Expert ENT and Diagnostic Centre, Barabanki, Uttar Pradesh, India



COVID-19, Oral, Laryngopharyngeal, Pandemic, Guidelines


The pandemic due to the new respiratory infection known as coronavirus 2019 disease (COVID-19), caused by the SARS-CoV-2 virus, has triggered an unprecedented disruption in the normal activity of ENT, oral, and pharyngeal surgery departments worldwide, delaying routine patient care and elective surgical interventions. ENT, oral, and pharyngeal surgeons are one of the healthcare groups with the highest risk of nosocomial infection because of the close contact that occurs with asymptomatic and symptomatic patients with SARS-CoV-2 infection through the oral cavity and laryngopharynx. The purpose of this document has been to update the available evidence for the safe and effective management and treatment in elective and emergency surgeries, and hospitalization, while minimizing as much as possible the risk of infection for the ENT, oral, and laryngopharyngeal surgeon, health workers and patients. This document aims to clarify the most significant aspects and develop a common protocol for the surgical management of patients with COVID-19 in ENT, oral, and maxillofacial surgery during the acute stage of spread and subsequent control of the pandemic in our country.

Author Biographies

Parvez Husain, Department of ENT, Expert ENT and Diagnostic Centre, Barabanki, Uttar Pradesh, India

Department Of ENT, Consultant.

Benazeer Husain, Department of ENT, Expert ENT and Diagnostic Centre, Barabanki, Uttar Pradesh, India

Department of Oral Pathology

Consultant Pathologist 

Shaheen Khalil Ahmed, Department of ENT, Expert ENT and Diagnostic Centre, Barabanki, Uttar Pradesh, India

Department of Anaesthesia 



Zhang T, Liu T, Yu L. Instructions for management of oral andmaxillofacial trauma during prevention and control stage of the novelcoronavirus infection. Chin J Oral Maxillofac Surg. 2020;2:100-4.

Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med. 2020;382(12):1177-9.

Advice on the use of masks in the context of COVID-19. Interim guidance. Geneva: World Health Organization. 2020. Available at: https://www Accessed on 22 January 2021.

Lancet T. COVID-19: protecting health-care workers. The Lancet. 2020;395:922.

Lei S, Jiang F, Su W et al (2020) Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. E Clin Med. 2020;21:100331.

Al-Muharraqi MA (2020) Testing recommendation for COVID- 19 (SARS-CoV-2) in patients planned for surgery—continuing the service and ‘suppressing’ the pandemic. Br J Oral Maxillofac Surg. 2020;58(5):503-5.

Patel R, Babady E, Theel ES, Storch GA, Pinsky BA, St George K, Smith TC, Bertuzzi S. Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of Diagnostic Testing for SARS-CoV-2/COVID-19. mBio. 2020;11(2):e00722-20.

Academy of Medical Royal Colleges. Clinical guide for the management of essential cancer surgery for adults during the coronavirus pandemic. 2020. Available at: /coronavirus/wp-content/uploads/sites/52/2020/04 /C0239- Specialty-guide-Essential-Cancer-surgery-and-coronavirus-v1-70420.pdf 5. Accessed on 22 January 2021.

Available at: publications/wuhan-novel-coronavirus-infectionprev ention-and-control. Accessed on 22 January 2021.

Schentag JJ, Akers C, Campagna P, Chirayath P. SARS: clearing the air. Institute of Medicine (US) Forum on Microbial Threats; Knobler S, Mahmoud A, Lemon S, et al, editors. National Academies Press, Washington. 2004.

Wilkes AR. Heat and moisture exchangers and breathing system filters: their use in anaesthesia and intensive care. Part 1: history, principles and efficiency. Anaesthesia. 2011;66:31-9.

AO CMF. 2020. Available at: https://aocmf3. Accessed on 26 April 2020.

Geller C, Varbanov M, Duval RE. Human coronaviruses: insights into environmental resistance and its influence on the development of new antiseptic strategies. Viruses. 2012;4:3044-68.

Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In Vitro Bactericidal and Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash Against Respiratory and Oral Tract Pathogens. Infect Dis Ther. 2018;7(2):249-59.

Kanagalingam J, Chopra A, Hong M, Ibrahim W, Villalon A, Lin J. Povidone-iodine for the management of oral mucositis during cancer therapy. Oncol Rev. 2017;11(2).

Panchmatia R, Payandeh J, Al-Salman R, Kakande E, Habib A, Mullings W, et al. The efficacy of diluted topical povidone-iodine rinses in the management of recalcitrant chronic rhinosinusitis: a prospective cohort study. Eur Arch Oto-Rhino-Laryngol. 2019;276(12):3373-81.

Rezapoor M, Nicholson T, Tabatabaee R, Chen A, Maltenfort M, Parvizi J. PovidoneIodine–Based Solutions for Decolonization of Nasal Staphylococcus aureus : A Randomized, Prospective, Placebo-Controlled Study. J Arthroplast. 2017;32(9):2815-9.

Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hospital Infect. 2020;104(3):246-51.

Appendix B. Air guidelines for environmental infection control in health-care facilities, U.S, HHS. 2003. Available at: control/guidelines/environmental/appendix/air.html. Assessed 20 April 2020.

SIAARTI—Covid 19—Airway management. Available at: Accessed on 30 April 2020.

Singh N, Rao PB, Mishra N. Video laryngoscopy in COVID-19 patients: a word of caution. Can J Anaesth. 2020;67(9):1291.

Effect of Fentanyl on Coughing and Recovery After Anesthesia With an LMA Laryngeal Mask Airway for Airway Management— Full Text View— Available at: https://clinicaltrials .gov/ct2/show/NCT01368809. Accessed 30 April 2020.

Levin MA, McCormick PJ, Lin HM. Low intraoperative tidal volume ventilation with minimal PEEP is associated with increased mortality. Br J Anaesth. 2014;113:97-108.

Rajan N, Joshi GP. The COVID-19: Role of Ambulatory Surgery Facilities in This Global Pandemic. Anesth Analg. 2020.

Pedersen A, Getty Ritter E, Beaton M, Gibbons D. Remote video auditing in the surgical setting. AORN J. 2017;105:159-69.






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