Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic:Current practice and lessons for the future

The coronavirus disease 2019(COVID-19)pandemic has imposed a radical change in daily life and work routine.In this context,health systems have suffered important and serious repercussions in all fields.Among the changes brought about by the state of global health emergency,adjustments to guidelines,priorities,structures,professional teams,and epidemiological data stand out.In light of this,the oncological field has witnessed several changes in the approach to cancer,whether due to delay in diagnosis,screening deficit,personnel shortage or the psychological impact that the pandemic has had on cancer patients.This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency.In this period,the oral and maxillofacial surgeons have faced many obstacles.The proximity of maxillofacial structures to the airways,the need of elective and punctual procedures in cancerous lesions,the aggressiveness of head and neck tumors,and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field.One of the possible surgical'solutions'to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps,which in the pre-COVID-19 era were less used than free flaps.However,during the health emergency,its use has been widely reassessed.This setback may represent a precedent for opening up new reflections.In the course of a long-term pandemic,a reassessment of the validity of different medical and surgical therapeutic approaches should be considered.Finally,given that the pandemic has highlighted vulnerabilities and shortcomings in a number of ways,including the issues of essential resource shortages,underinvestment in public health services,lack of coordination and versatility among politicians,policymakers and health leaders,resulting in overloaded health systems,rapid case development,and high mortality,a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out.This should be directed especially towards improving the management of health systems,their coordination as well as reviewing related practices,even in the surgical field.

eHealth,telehealth,and telemedicine in the management of the COVID-19 pandemic and beyond:Lessons learned and future perspectives

In this article,we discuss evidence supporting the effective implementation of e Health,telehealth,and telemedicine during the coronavirus disease 2019 pandemic,with a view towards its permanent future integration in healthcare.We performed a literature search for articles describing the use of telehealth/telemedicine in the pandemic context using five databases.The articles selected describe the use of telemedicine as its advantages in terms of practicality and costeffectiveness.This synthesis of articles is applicable to high-,middle-and lowincome countries.Some of the notable benefits include breaking down geographical and time barriers,reducing waiting lists and crowding in healthcare facilities,and saving on national healthcare expenditure.However,there are a number of difficulties with the widespread implementation of telemedicine services that mainly relate to bureaucratic and regulatory concerns.Moreover,it is also important to make healthcare professionals and providers aware of the limits of this tool to avoid potential cases of negligence.Patients in turn will have to be made aware of and be educated on the use of this new healthcare modality before it is accepted by them.In the current socio-economic climate,it is therefore essential to implement a telehealth model aimed at efficiency and continuity of healthcare,as well as leading to an improvement in the quality of life of patients,whilst optimising existing resources and reducing costs.In that regard,the adoption of e Health,telehealth,and telemedicine services should be considered highly timely,despite current existing limitations.