Suction mitigation of airborne particulate generated during sinonasal drilling and cautery

Abstract

Background Coronavirus disease COVID-has significantly impacted endonasal surgery and recent experimentation has demonstrated that sinonasal drilling and cautery have significant propensity for airborne particulate generation immediately adjacent to the surgical field In the present investigation we assessed nasopharyngeal suctioning as a mitigation strategy to decrease particulate spread during simulated endonasal surgical activity Methods Airborne particulate generation in the-μm toμm range was quantified with an optical particle sizer in realtime during cadaveric-simulated anterior and posterior endonasal drilling and cautery conditions To test suction mitigation experiments were performed both with and without a rigid suction placed in the contralateral nostril terminating in the nasopharynx Results Both anterior medial maxillary wall and nasal septum and posterior sphenoid rostrum drilling produced significant particulate generation in the-μm to-μm range throughout the duration of drilling p < without the use of suction whereas nasopharyngeal suction use eliminated the detection of generated airborne particulate A similar effect was seen with nasal cautery with significant particle generation p < that was reduced to undetectable levels with the use of nasopharyngeal suction Conclusion The use of nasopharyngeal suctioning via the contralateral nostril minimizes airborne particulate spread during simulated sinonasal drilling and cautery In the era of COVID-this technique offers an immediately available measure that may increase surgical safety © 2020 ARS-AAOA, LLC.

Aerosol and droplet generation from mandible and midface fixation: Surgical risk in the pandemic era

“…While it is well known that smoke evacuation systems are effective at aerosol and infection mitigation [ 27 ], this novel demonstration of its efficacy in the setting of craniomaxillofacial trauma highlights its usefulness during this era of heightened concern for aerosolization of SARS-CoV-2. Moreover, this finding further complements the growing literature of suction devices mitigating aerosol generation [ 11 , 13 , 14 ].…”

“…However, an overall lack of objective data has impeded decision making on key topics including PPE recommendations and pre-procedural COVID-19 testing. While aerosol and droplet generation has been demonstrated from other head and neck procedures in areas such as endonasal and otologic surgery [ 11 , [17] , [18] , [19] , 21 ], there is little published data on the treatment of facial trauma. This is a key knowledge gap as surgical fixation of facial fractures often requires interaction with the same mucosal surfaces in the oral and nasal cavity which have been demonstrated to harbor high viral loads in infected patients [ 8 ], and surgeries often cannot be deferred to allow viral infections to clear [ 5 , 6 ].…”

“…The virus has also been isolated in the mastoid and middle ear [ 10 ]. Several recent studies have demonstrated droplet and aerosol generation from endonasal and otologic procedures, with suction techniques and custom barrier devices demonstrating effectiveness at mitigating dispersion of these particulates [ [11] , [12] , [13] , [14] ]. Although the generation of droplets and aerosols during rhinologic and otologic procedures has been of particular interest during the COVID-19 pandemic due to instrumentation of the mucosal surface lining, surgeries involving the oral cavity, which has been demonstrated as a significant viral reservoir [ 15 , 16 ], likely also pose significant risk.…”

Innovations in otorhinolaryngology in the age of COVID‐19: A systematic literature review

“…This solution was only tested on a cadaver model, which may not adequately capture real-life aerosolization as it does not account for the air flow rates in the local environment. 18 , 19 In other cadaver experiments, Workman et al 51 found that the use of nasopharyngeal suctioning via a rigid suction in the contralateral nostril minimizes airborne particulate spread during simulated sinonasal drilling and cautery.…”

“… Nasopharyngeal suctioning via rigid suction placed in the contralateral nostril to limit particulate spread during sinonasal drilling. Workman AD, Xiao R, Feng A, et al 51 Preclinical evaluation of intervention: comparison Level 4 (case-control simulation) Risk of Bias: Moderate(cadaver study and lab setting may not accurately reflect in vivo OR conditions) These studies were conducted in the cadaver model. Suctioning is effective in reducing aerosol contamination.…”