Location
Suwanee, GA
Start Date
7-5-2024 1:00 PM
End Date
7-5-2024 4:00 PM
Description
Introduction:
The COVID-19 pandemic in 2020 brought a profound global shift particularly in medicine and daily life (2). Within healthcare, masks assumed heightened significance as frontline workers attended to potentially infected/infected patients. Initially, limited data existed on effectiveness, mask types, and ideal duration of use, resulting in a generalized protocol of patients and the healthcare team wearing masks during healthcare visits (3). While serving as a shield against COVID-19, masks also possess the potential to conceal subtle disease indicators present only beneath their covering. Notably, no studies to date have explored whether the widespread use of masks throughout the pandemic inadvertently led to missed clinical signs, consequently affecting diagnoses and treatment options among the patient population. This case presents a 67-year-old male whose mask obscured a critical clinical sign; that is, inadvertently concealing a malignant parotid gland tumor (1).
Case Presentation:
A 67-year-old male presented for a cardiology examination. He denied any complaints. His extensive medical history included coronary disease with percutaneous intervention of the left anterior descending artery and first diagonal, hypertension, anomalous right coronary artery repaired with surgical reimplantation, emphysema, hepatitis C and schizophrenia. On examination, the patient was sitting comfortably wearing a mask. His left eye appeared to be congested with some ectropion; on opening his mask facial palsy on the left side of his face was noted. Since he was not having any distressing symptoms he did not seek medical attention. He was immediately sent to his primary care physician's office and underwent further evaluation.
Bell's palsy was diagnosed, which was found to be caused by a left salivary gland tumor. He underwent surgical resection with radiation treatment for 6 weeks and chemotherapy. Subsequently, he developed osteoradionecrosis (ORN) of the left temporomandibular joint for which he had to receive intravenous antibiotics and hyperbaric oxygen therapy. He is still weak and fatigued from chemotherapy side effects undergoing physical therapy and nutritional counseling for weight loss but unfortunately left with permanent disfigurement of his face due to ORN which could have been potentially avoided with earlier diagnosis.
Discussion
This represents a case where due to the pandemic, diagnosis was delayed in this patient who did not report any symptoms. The clinical signs were hidden as the patient was wearing a mask when he was seeing his physicians. Due to the delay in diagnosis, his disease had advanced requiring chemotherapy and radiation therapy with subsequent complications that could have been avoided if it had been diagnosed earlier and treated just with surgical resection. In the absence of any clinical literature on this, statistical numbers could not be obtained on how many patients may have been affected during the pandemic because of masking. Understanding the potential impact of masks on obscuring clinical signs and symptoms is crucial. Missed diagnoses due to masks leading to treatment delays or even complete oversight in identifying certain health issues need further evaluation with research and probably modified healthcare protocols for balanced infection control measures and clinical assessments during public health issues.
Embargo Period
7-2-2024
Included in
Masking During the Pandemic: Their Role in Possible Delaying Medical Diagnoses; A Case Report
Suwanee, GA
Introduction:
The COVID-19 pandemic in 2020 brought a profound global shift particularly in medicine and daily life (2). Within healthcare, masks assumed heightened significance as frontline workers attended to potentially infected/infected patients. Initially, limited data existed on effectiveness, mask types, and ideal duration of use, resulting in a generalized protocol of patients and the healthcare team wearing masks during healthcare visits (3). While serving as a shield against COVID-19, masks also possess the potential to conceal subtle disease indicators present only beneath their covering. Notably, no studies to date have explored whether the widespread use of masks throughout the pandemic inadvertently led to missed clinical signs, consequently affecting diagnoses and treatment options among the patient population. This case presents a 67-year-old male whose mask obscured a critical clinical sign; that is, inadvertently concealing a malignant parotid gland tumor (1).
Case Presentation:
A 67-year-old male presented for a cardiology examination. He denied any complaints. His extensive medical history included coronary disease with percutaneous intervention of the left anterior descending artery and first diagonal, hypertension, anomalous right coronary artery repaired with surgical reimplantation, emphysema, hepatitis C and schizophrenia. On examination, the patient was sitting comfortably wearing a mask. His left eye appeared to be congested with some ectropion; on opening his mask facial palsy on the left side of his face was noted. Since he was not having any distressing symptoms he did not seek medical attention. He was immediately sent to his primary care physician's office and underwent further evaluation.
Bell's palsy was diagnosed, which was found to be caused by a left salivary gland tumor. He underwent surgical resection with radiation treatment for 6 weeks and chemotherapy. Subsequently, he developed osteoradionecrosis (ORN) of the left temporomandibular joint for which he had to receive intravenous antibiotics and hyperbaric oxygen therapy. He is still weak and fatigued from chemotherapy side effects undergoing physical therapy and nutritional counseling for weight loss but unfortunately left with permanent disfigurement of his face due to ORN which could have been potentially avoided with earlier diagnosis.
Discussion
This represents a case where due to the pandemic, diagnosis was delayed in this patient who did not report any symptoms. The clinical signs were hidden as the patient was wearing a mask when he was seeing his physicians. Due to the delay in diagnosis, his disease had advanced requiring chemotherapy and radiation therapy with subsequent complications that could have been avoided if it had been diagnosed earlier and treated just with surgical resection. In the absence of any clinical literature on this, statistical numbers could not be obtained on how many patients may have been affected during the pandemic because of masking. Understanding the potential impact of masks on obscuring clinical signs and symptoms is crucial. Missed diagnoses due to masks leading to treatment delays or even complete oversight in identifying certain health issues need further evaluation with research and probably modified healthcare protocols for balanced infection control measures and clinical assessments during public health issues.