Droplet and Aerosol Generation With Endonasal Surgery: Methods to Mitigate Risk During the COVID-19 Pandemic.
Otolaryngol Head Neck Surg
; 164(2): 285-293, 2021 02.
Article
in English
| MEDLINE | ID: covidwho-1140419
ABSTRACT
OBJECTIVE:
To define the aerosol and droplet risks associated with endonasal drilling and to identify mitigation strategies. STUDYDESIGN:
Simulation series with fluorescent 3-dimensional (3D) printed sinonasal models and deidentified cadaveric heads. SETTINGS Dedicated surgical laboratory. SUBJECTS ANDMETHODS:
Cadaveric specimens irrigated with fluorescent tracer and fluorescent 3D-printed models were drilled. A cascade impactor was used to collect aerosols and small droplets of various aerodynamic diameters under 15 µm. Large droplet generation was measured by evaluating the field for fluorescent debris. Aerosol plumes through the nares were generated via nebulizer, and mitigation measures, including suction and SPIWay devices, nasal sheaths, were evaluated regarding reduction of aerosol escape from the nose.RESULTS:
The drilling of cadaveric specimens without flexible suction generated aerosols ≤3.30 µm, and drilling of 3D sinonasal models consistently produced aerosols ≤14.1 µm. Mitigation with SPIWay or diameter-restricted SPIWay produced same results. There was minimal field contamination in the cadaveric models, 0% to 2.77% field tarp area, regardless of drill burr type or drilling location; cutting burr drilling without suction in the 3D model yielded the worst contamination field (36.1%), followed by coarse diamond drilling without suction (19.4%). The simple placement of a flexible suction instrument in the nasal cavity or nasopharynx led to complete elimination of all aerosols ≤14.1 µm, as evaluated by a cascade impactor positioned immediately at the nares.CONCLUSION:
Given the findings regarding aerosol risk reduction, we strongly recommend that physicians use a suction instrument in the nasal cavity or nasopharynx during endonasal surgery in the COVID-19 era.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Infectious Disease Transmission, Patient-to-Professional
/
Aerosols
/
Natural Orifice Endoscopic Surgery
/
Nasal Surgical Procedures
/
COVID-19
Type of study:
Experimental Studies
/
Prognostic study
Limits:
Humans
Language:
English
Journal:
Otolaryngol Head Neck Surg
Journal subject:
Otolaryngology
Year:
2021
Document Type:
Article
Affiliation country:
0194599820949802
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