The COVID-19 pandemic has complicated the management of head and neck cancers, particularly for patients with underlying immunosuppressive disorders. The imposition of protective precautions has tasked head and neck oncologists with the need to temper the risks of cancer progression while managing the risks implicit in increased susceptibility to life-threatening complications from viral exposure.
Necessary head and neck cancer surgeries continued at the Department of Otorhinolaryngology-Head and Neck Surgery in the days and weeks after the onset of the COVID pandemic in Philadelphia. As the following case reports demonstrate, the treatment of these complex patients required not only depth of experience, but an evolving algorithm defined by on the spot innovation, rapid decision-making and truncated response times.
When originally published in a slightly different format, the three cases that follow were intended at publication to provide guidance to clinicians struggling with how to best counsel and manage this unique subset of patients under the difficult circumstances of the COVID era.
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Mr. A, a 60-year-old male, presented to the emergency department (ED) with progressive stridor requiring urgent airway evaluation. His history was notable for radical tonsillectomy, neck dissection, radial forearm free flap, and tracheostomy for a locally and regionally advanced p16+ squamous cell carcinoma (SCCA) approximately two months earlier
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Mr. C, 46-year-old male with a history of aplastic anemia and allogeneic hematopoietic stem cell transplantation complicated by chronic graft versus host disease (GVHD) resulting in multiple past squamous cell carcinomas (SCC) of the oral cavity, presented with a new tongue lesion.
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Mrs. T, 39-year-old female, never-smoker, with a history of squamous cell carcinoma in situ of the right true vocal cord, longstanding Crohn's disease, and gastroesophageal reflux, presented with a cough and sore throat.