WUTH publication: Reducing the risks of endoscopic sino-nasal surgery in the Covid-19 era

Citation: Clinical Otolaryngology. 2021 Feb 16. Online ahead of print
Author: Leong SC, Mogre D, Andrews P, Davies E
Abstract: Objectives: Many powered instruments used in routine sinonasal surgery are regarded as an aerosol generating procedure (AGP). This study aimed to assess assess how different instrument settings may affect detectable droplet spread and the patterns of aerosolised droplet spread during simulated sinonasal surgery with powered instrumentation in order to identify mitigation strategies.
Design: Simulation series using three-dimensional (3D) printed sinonasal model. Fluorescein droplet spread was assessed following microdebriding and drilling of fluorescein-soaked grapes and bones respectively.
Setting: University dry lab.
Participants: 3-D printed sinonasal model.
Main outcome measures: Patterns of aerosolised droplet spread.
Results and conclusion: There were no observable fluorescein droplets or splatter in the measured surgical field after microdebridement of nasal polyps at a specific irrigation rate and suction pressure. Droplet splatter occurred when suction pressure was reduced; simulating a surgical condition where there was excessive fluid in the nasal cavity irrigation. Drilling with either coarse diamond or cutting burr resulted in detectable droplets. Greater droplet spread was observed when drilling within the anterior nasal cavity. The addition of a suction catheter reduces droplet spread when drilling. Activation of the microdebrider when there is fluid excess fluid (reduced or blocked suction pressure, excessive mucosal bleeding or irrigation fluid) accumulating in the nasal cavity resulted in detectable droplet spread. High-speed drilling is a high-risk AGP especially when drilling in the anterior nasal cavity, but the addition of suction reduces detectable droplet spread outside the nasal cavity.
Keywords: COVID-19; aerosol-generating Procedure; droplet; nasal endoscopy; sinus surgery; skull base surgery.

Link to PubMed record