Lizambri Daniele, Giacalone Andrea, Shah Pritik A, Tovani-Palone Marcos Roberto
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Caserta 81100, Italy.
Department of Industrial Engineering, Technologies for Sports Medicine and Rehabilitation, University of Rome Tor Vergata, Rome 00133, Italy.
World J Clin Cases. 2023 Mar 6;11(7):1434-1441. doi: 10.12998/wjcc.v11.i7.1434.
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 high-lighted 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.
2019年冠状病毒病（COVID-19）大流行给日常生活和工作模式带来了根本性变化。在此背景下，卫生系统在各个领域都受到了重大且严重的影响。在全球卫生紧急状态带来的诸多变化中，指南、优先事项、结构、专业团队以及流行病学数据的调整尤为突出。鉴于此，肿瘤领域在癌症治疗方法上发生了诸多变化，这或是由于诊断延迟、筛查不足、人员短缺，抑或是大流行对癌症患者产生的心理影响所致。本文聚焦于口腔癌的管理以及在卫生紧急状态期间口腔颌面专科医生所采用的手术方法。在此期间，口腔颌面外科医生面临了诸多障碍。颌面结构与气道相邻、癌性病变需要择期和及时手术、头颈部肿瘤的侵袭性以及支持此类精细手术所需的高昂医疗费用，这些都是该领域所面临的部分挑战。大流行期间，口腔癌手术病例管理困难的一种可能的手术“解决方案”是局部皮瓣，在COVID-19大流行之前，其使用频率低于游离皮瓣。然而，在卫生紧急状态期间，其使用已得到广泛重新评估。这一挫折可能为开启新的思考提供一个先例。在长期的大流行过程中，应考虑重新评估不同医疗和手术治疗方法的有效性。最后，鉴于大流行在许多方面凸显了脆弱性和缺陷，包括基本资源短缺、对公共卫生服务投资不足、政治家、政策制定者和卫生领导人之间缺乏协调与灵活性，导致卫生系统不堪重负、病例快速增加和高死亡率，对不同卫生系统为令人满意地应对未来紧急情况所需的变化进行更仔细的分析至关重要。这尤其应指向改善卫生系统的管理、它们的协调以及审查相关做法，即使在外科领域也是如此。
