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2020 ; 163
(1
): 145-150
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gab.com Text
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Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet
Splatter Patterns During the COVID-19 Pandemic
#MMPMID32423283
Sharma D
; Rubel KE
; Ye MJ
; Shipchandler TZ
; Wu AW
; Higgins TS
; Burgin SJ
; Ting JY
; Illing EA
Otolaryngol Head Neck Surg
2020[Jul]; 163
(1
): 145-150
PMID32423283
show ga
OBJECTIVE: The 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
DESIGN: Cadaver simulation series. SETTING: Dedicated surgical laboratory.
SUBJECTS AND METHODS: 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. RESULTS: There 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). CONCLUSION: Our 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.