Gadkaree Shekhar K, Derakhshan Adeeb, Workman Alan D, Feng Allen L, Quesnel Alicia M, Shaye David A
Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
Facial Plast Surg Aesthet Med. 2020 Jul 2. doi: 10.1089/fpsam.2020.0322.
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. Airborne particulate generation in the 1-10 μm 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). Mandibular plate screw drilling without irrigation generated significant particulate both adjacent to the surgical site and at SML ( < 0.01). Irrigation mitigated particulate generation at SML to nonsignificant levels. Calvarial drilling additionally produced substantial particulate above baseline adjacent to the surgical site ( < 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 ( < 0.001) and at SML ( < 0.01). At SML, smaller particulate represented a significantly higher proportion of total particulate detected. 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.
由于鼻腔和鼻咽部病毒载量高，新冠病毒在头颈部手术过程中构成潜在的重大感染风险。在颅颌面创伤手术和鼻整形手术中，面部整形手术会大量暴露于这些区域。在尸体模拟鼻整形手术和面部创伤情况下，使用光学粒子计数器实时定量1-10μm范围内的空气传播颗粒。测试的手术包括下颌骨钢板螺钉钻孔、颅骨钻孔、鼻骨截骨术、鼻背锉磨和使用压电锯。在手术部位附近和外科医生嘴部水平（SML）测量颗粒生成情况。不冲洗的下颌骨钢板螺钉钻孔在手术部位附近和SML均产生大量颗粒（<0.01）。冲洗可将SML处的颗粒生成减轻到无显著水平。颅骨钻孔在手术部位附近还产生大量高于基线的颗粒（<0.01）。标准鼻截骨术和鼻背锉磨未产生可检测到的空气传播颗粒，而使用压电锯在手术部位附近（<0.001）和SML（<0.01）均与大量颗粒生成有关。在SML，较小颗粒在检测到的总颗粒中所占比例显著更高。大多数颅颌面创伤手术会产生颗粒，使用局部冲洗可能会限制其传播范围。鼻整形术中涉及的大多数骨操作可以在不形成大量颗粒的情况下安全进行。在担心产生颗粒时，鼻整形术中应避免使用压电器械。
