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Development of a Low-Cost Mask for Prevention of Aerosols Spreading in Endonasal Endoscopic Procedures to the Skull Base during the COVID-19 Pandemic
Introduction: The outbreak of coronavirus disease 2019 (COVID-19) due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has changed our daily basis practice. Some reports suggest that COVID-19 patients that undergo an endonasal endoscopic approach (EEA) should be considered potential superspreaders given the manipulation area during the procedures and aerosols production while drilling over the paranasal sinuses. The number of direct and indirect tests for COVID-19 diagnosis are limited in low-to-middle income countries (LMICs) and the time to obtain results may vary between 5 and 10 days. Consequently, screening processes for all patients that require an EEA are limited in most institutions in LMICs. Given this context, it is of utmost importance the development of different tools to decrease the transmission of the virus.
Objective: Develop a mask for patient placement during EEA that is easy to use, inexpensive, sterilizable, and reusable.
Methods and Results: An initial model was designed based on the need to decrease the aerosols produced during drilling to redirect these particles to a container to prevent contamination of the mucosa of all health caregivers in the operating room. The mask was developed to cover both nose and mouth, while allowing proper endotracheal tube insertion and fixation based on a two-piece mount: a casted skin contact surface and a 3D printed mount for instrumentation and negative pressure. Three holes were modeled in the mask: (1) one for the endotracheal tube (in the silicone surface), (2) one for surgical instrumentation (slightly larger, located in the middle allowing placement of a translucent sterile cover), and (3) a small one at the top that enables a suction line connection to create negative pressure ([Fig. 1]). Patient's skin contact surface was created by means of a room-temperature vulcanizing silicone surface. Three anchor points for straps to adjust the mask to the patient's head for long periods of time without producing injuries. The 3D model was designed on Autodesk Fusion 360 and Meshmixer (Fig. 2) and was built with polylactic acid (PLA) using a 3D printer (PRUSA IK3 MK3s, Prague, Czech Republic) in Bogota, Colombia. Tests were performed at the Microsurgical and Endoscopic Training laboratory, including ultraviolet (UV) light verification of fluorescein spread after bone drilling, chemical and heating sterilization, and suction of aerosols produced by an electronic cigarette. The anatomical structure of the design was based on the masks used for anesthetic induction in a routine fashion and the senior surgeons' criteria when performing EEAs for anterior and middle fossa lesions. The measurements of the mask were standardized for adult patients.
Conclusion: This study describes the development of a mask to improve the safety of endonasal endoscopic procedures reducing the transmission of the SARS-CoV-2 between the patient and the surgeon, providing a rapid prototype of a low-cost mask.
No conflict of interest has been declared by the author(s).
12 February 2021 (online)
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