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