Diagnosis and Treatment of Midface Trauma in the Context of Polytrauma: Characteristics during COVID-19 Pandemic Conditions

Abstract

Midfacial trauma is never an immediate therapeutic emergency excepting cases with nasal bleeding and risk of aspiration or requiring a permeable airway that will allow intubation when appropriate. The patient with polytraumas and midfacial fractures who needs ear, nose, and throat (ENT) or oral and maxillofacial (OMF) surgery should be reassessed at 24 and 48 hours to determine the optimal operating time. The surgical indication should be established according to esthetic and functional deficits. We consider that the optimal operative moment for the lesions of the midface is at 4–5 days after the trauma, under the conditions of a stable hemodynamic, respiratory, and afebrile patient. We propose the schematic presentation of the principles of diagnosis and treatment for midface trauma. We will discuss also some aspects of midfacial trauma during coronavirus disease-2019 (COVID-19) pandemic conditions. We must assume every patient with polytrauma as a COVID-19-positive patient. So, it is necessary to have a special circuit for a suspect COVID-19 polytrauma patient between emergency room (ER) department, operating room, and intensive care unit (ICU). All medical team must wear high-level personal protective equipment (PPE) during emergency treatment of a craniofacial trauma in the context of polytrauma until we get the result of RT-PCR testing.