Abstract
Purpose Due to the potential risk of COVID-19 transmission during endonasal surgery, we studied
methods to reduce droplet and aerosol generation during these procedures.
Methods Droplet spread was assessed using ultraviolet light and a camera that detected fluorescence
in the operative field and surgeon's personal protective equipment. Density of aerosols
sized <10 µm was measured using a photometric particle counter. We designed a face-mounted
negative-pressure mask placed on the patients' face during endoscopic endonasal surgery.
Sixteen patients were recruited between October 2020 and March 2021 and randomly assigned
to the mask and no-mask groups. We compared droplet spread and aerosols generated
in both groups, with copious irrigation and continuous suction during drilling forming
the mainstay of surgical technique in all cases.
Results Droplet contamination due to direct spillage of fluorescein from the syringe was
noted in two patients. Aerosol density rose during sphenoid drilling in both groups,
with no significant difference when continuous suction and irrigation were employed
(1.27 times vs. 1.07 times the baseline, p = 0.248). Aerosol density rose significantly when suction and irrigation were interrupted
in the no-mask group (44.9 times vs. 1.2 times, p = 0.028), which was not seen when the mask was used.
Conclusion Aerosol generation increases during drilling in endonasal procedures and is a concern
during this pandemic. The use of a rigid suction close to the drill along with copious
irrigation is effective in reducing aerosol spread. The use of a negative pressure
mask provides additional safety when inadvertent blockage of suction and inadequate
irrigation occur.
Keywords
aerosol - droplet - generation - mask - suction - endonasal surgery
