Quantifying Aerosolization of Facial Plastic Surgery Procedures in the COVID-19 Era: Safety and Particle Generation in Craniomaxillofacial Trauma and Rhinoplasty

Abstract

Background: COVID-19 poses a potentially significant infectious risk during procedures of the head and neck due to high viral loads in the nasal cavity and nasopharynx. Facial plastic surgery has significant exposure to these areas during craniomaxillofacial trauma procedures and rhinoplasty. Methods: Airborne particulate generation in the 1-10 lm range was quantified with an optical particle sizer in real time during cadaveric-simulated rhinoplasty and facial trauma conditions. Procedures tested included mandibular plate screw drilling, calvarial drilling, nasal bone osteotomy, nasal dorsal rasping, and piezoelectric saw use. Particulate generation was measured both adjacent to the surgical site and at surgeon mouth level (SML). Results: Mandibular plate screw drilling without irrigation generated significant particulate both adjacent to the surgical site and at SML (p < 0.01). Irrigation mitigated particulate generation at SML to nonsignificant levels. Calvarial drilling additionally produced substantial particulate above baseline adjacent to the surgical site (p < 0.01). Standard nasal osteotomies and dorsal rasping did not generate detectable airborne particulate, whereas piezoelectric saw use was associated with significant particulate generation both adjacent to the surgical site (p < 0.001) and at SML (p < 0.01). At SML, smaller particulate represented a significantly higher proportion of total particulate detected. Conclusions: The majority of craniomaxillofacial trauma procedures involve particle generation that may be limited in spread by the use of local irrigation. Most bony work involved in rhinoplasty can be safely performed without a high degree of particle formation. The use of piezoelectric instruments in rhinoplasty should be avoided when concerned for particulate generation.

Pandemics and facial plastics and reconstructive surgery

“…This was decreased to nonsignificant levels when irrigation was added. As expected, cranial bone drilling and piezoelectric saw use created significant particulate generation however nasal osteotomies and nasal rasping did not 14 . These results contradicted most protocols and demonstrated the importance of irrigation to minimize aerosol generation.…”

“…Most facial trauma guidelines recommended limiting the use of powered instrumentation and associated irrigation, presuming this would worsen the amount of particle generation. Interestingly, a study performed by Gadkaree et al evaluated the safety and particle generation of multiple procedures by quantifying the level of airborne particulate generation during rhinoplasty and facial trauma procedures 14 . During mandibular plate screw drilling without the use of irrigation the authors found that significant particulate was generated at the surgeon's mouth level.…”

Aerosol and droplet generation from mandible and midface fixation: Surgical risk in the pandemic era

“…Differences compared to other types of drilling may be due to the smaller caliber of drill bit and short duration of use. In addition, recent literature suggests that using irrigation while drilling as in this study mitigates aerosol generation [ 29 ].…”

Laryngeal complications of COVID‐19

“…The COVID-19 pandemic caused by the novel SARS-CoV-2 virus has upended the world of otolaryngology. In only a few months, it has changed the way otolaryngologists think about how we protect ourselves in the office and operating room, [1][2][3][4][5][6] how we think about aerosolizing procedures, [7][8][9][10][11][12] and how we participate in telemedicine. [13][14][15][16][17] Several aspects of the pandemic affect otolaryngologists in particular.…”