Sinonasal and Skull base (high risk for viral aerosolization)
All endoscopic sinus surgery/endoscopic endonasal approaches are considered high risk procedures for viral aerosolization13, therefore all routine nasal endoscopy and debridement for follow-up should deferred when possible. Patients with inflammatory disease or non-malignant tumors should be deferred. Alternative non-surgical interventions should be considered for patients with active malignancies requiring treatment.
o   Intermediate stage tumors
·              Consider for chemoradiation or radiation therapy alone
 
o   Advanced mucosal derived malignancies
                ·              Sinonasal undifferentiated carcinoma or Squamous cell carcinoma should be                             considered for  neoadjuvant chemotherapy
                ·              Sinonasal mucosal melanoma should be considered for neoadjuvant immunotherapy or targeted therapy
                ·              Skull base sarcomas should be considered for radiation therapy
 
o   Low grade and slow growing neuroendocrine carcinoma (NEC) and olfactory neuroblastoma (ONB)
                 ·              Defer and monitor with periodic imaging
 
o   Tumors of minor salivary gland origin
                ·             Defer and monitor with periodic imaging unless rapidly growing
 
o   High grade NEC and Hyams Grade IV ONB
                ·              Consider neoadjuvant chemotherapy
Patients with unavoidable, emergent surgery (i.e. invasive fungal sinusitis, impending visual or neurological compromise): we recommend full PAPR equipment for all involved in the case and minimize nonessential personnel in the operating room (trainees, advanced practice providers, visitors, etc.).
 
Salivary Gland
·       Low-Grade and/or slow growing intermediate grade
               o   Defer to eight-week follow-ups with telemedicine visits 
·       Recommendations for intermediate grade lesions are determined on a case by case evaluation
·       Surgery should be considered in the following cases
               o   Pediatric population
               o   High-grade malignancies such as salivary duct carcinoma/Carcinoma ex                      pleomorphic/High-grade mucoepidermoid carcinoma
                            §  Neoadjuvant systemic therapy may be considered prior to surgery