Mastoid and temporal bone surgery
The mastoid and middle ear mucosa may carry the same risk of viral aerosolization as sinus and nasal surgery due to the connection with the nasopharynx through the Eustachian tube. At a minimum, N95 mask is required for mastoid surgery. PAPR is required for the surgeon and OR staff in patients with SARS-CoV-2 positive status, and this equipment can interfere with the use of an operative microscope. Using an exoscope is an alternative, but this equipment might not be widely available.
            o   Low-Grade and/or slow growing intermediate grade
                                ·         Defer
 
            o   Benign disease
                                ·    Delay surgery for uncomplicated benign disease (e.g. uncomplicated                                     cholesteatoma).  
·         Complicated benign disease (e.g. coalescent mastoiditis) might require surgical drainage limited to cortical mastoidectomy. Cholesteatoma with progressive facial paralysis generally requires surgical treatment to avoid progression to complete paralysis.  This benefit needs to be weighed against the potential hazard and risk to the surgeon and operating room personnel in a COVID positive patient.
 o   Malignant disease
                    ·         For early stage malignant disease of the ear canal, consider delaying for 4-6 weeks.
                    ·         For advanced stage malignant disease of the ear canal and temporal bone, consider                                 consider               djuvant consider   neodjuvant chemotherapy or immunotherapy.
 
Dental Oncology
o   Defer all elective oral surgical procedures (ambulatory and operating room)
o   Continue oral surgery procedures as part of head and neck surgery team procedure (e.g.,         planned dental extractions)
o   Continue fabrication of custom intra-oral stents for radiation therapy
o   Emergency cases considered on a case-based assessment
 
Ophthalmologic Malignancies and Procedures
·       Defer all benign cases unless they are sight threatening (certain hemangiomas)
·       Defer all low-risk/low-grade malignant tumors such as lid tumors and basal cell carcinomas by 8-12 weeks17
·       High-risk/higher-grade malignancies should be prioritized as delay is sight- and life-threatening
            o   Melanoma; retinoblastoma; rhabdomyosarcoma; choroidal metastasis
            o   Retinoblastoma and orbital rhabdomyosarcoma are of highest risk and surgery should be                   prioritized as delay is sight and life threatening
            o   Continue with ocular brachytherapy for selected cases
·       Other surgical procedures that should be considered due to risk of blindness18
            o   Temporal artery biopsy
            o   Orbital decompression
            o   Vitrectomy
            o   Retinal detachment repair19