Abstract
ObjectiveThe primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal procedures.Study DesignCadaver simulation series.SettingDedicated surgical laboratory.Subjects and MethodsAfter instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition.ResultsThere were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebrider-assisted turbinoplasty, cold-steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator. Limited droplet spread was noted with microdebrider FESS (2 droplets, <1 mm in size, within 10 cm), drilling of the sphenoid rostrum with a diamond burr (8, <1 mm, 12 cm), and drilling of the frontal beak with a cutting burr (5, <1 mm, 9 cm); however, the use of concurrent suction while drilling resulted in no droplets or splatter. The control condition of external activation of the drill resulted in gross contamination (11, 2 cm, 13 cm).ConclusionOur results indicate that there is very little droplet generation from routine rhinologic procedures. The droplet generation from drilling was mitigated with the use of concurrent suction. Extreme caution should be used to avoid activating powered instrumentation outside of the nasal cavity, which was found to cause droplet contamination.
Highlights
There were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebriderassisted turbinoplasty, cold-steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is responsible for the novel coronavirus disease 2019 (COVID-19), which has become an international pandemic through expansive community transmission
No observable fluorescein droplets were noted in the measured surgical field in any direction after any of the following procedures: (1) nasal endoscopy, (2) septoplasty with microdebrider-assisted turbinoplasty, (3) FESS performed with cold instrumentation, (4) drilling of the sphenoid rostrum with a cutting burr, (5) drilling of the frontal beak with a diamond burr, (6) drilling of the sphenoid rostrum with a diamond burr with concurrent suction, (7) drilling of the frontal beak with concurrent suction, (8) ultrasonic aspirator on the left sphenoid sinus, (9) use of the ultrasonic aspirator on the right frontal sinus, and (10) external activation of the ultrasonic aspirator
Summary
After instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition. The experiments in the study were all conducted in a dedicated surgical laboratory on 2 fresh-frozen cadaver head specimens prepared in identical fashion and placed in a standard supine surgical position. External ports into the frontal and maxillary sinuses were created as described below. A 4-mm round cutting burr was used to perform the external trephination opening an anterior window approximately 8 to 10 mm in size into both frontal sinuses. Entry was confirmed with endoscopic visualization of the posterior table. The maxillary sinus was approached with a Caldwell-Luc approach, and a similar bony window was created with a 4-mm round cutter burr with confirmation of entry with endoscopic visualization
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