Indiana University Department of Otolaryngology - Head & Neck Surgery, 1130 W Michigan St, FH 400, Indianapolis, IN 46202, USA.
Indiana University Department of Otolaryngology - Head & Neck Surgery, 1130 W Michigan St, FH 400, Indianapolis, IN 46202, USA.
Am J Otolaryngol. 2021 Jan-Feb;42(1):102829. doi: 10.1016/j.amjoto.2020.102829. Epub 2020 Nov 5.
The COVID-19 pandemic has led to concerns over transmission risk from healthcare procedures, especially when operating in the head and neck such as during surgical repair of facial fractures. This study aims to quantify aerosol and droplet generation from mandibular and midface open fixation and measure mitigation of airborne particles by a smoke evacuating electrocautery hand piece.
The soft tissue of the bilateral mandible and midface of two fresh frozen cadaveric specimens was infiltrated using a 0.1% fluorescein solution. Surgical fixation via oral vestibular approach was performed on each of these sites. Droplet splatter on the surgeon's chest, facemask, and up to 198.12 cm (6.5 ft) away from each surgical site was measured against a blue background under ultraviolet-A (UV-A) light. Aerosol generation was measured using an optical particle sizer.
No visible droplet contamination was observed for any trials of mandible or midface fixation. Total aerosolized particle counts from 0.300-10.000 μm were increased compared to baseline following each use of standard electrocautery (n = 4, p < 0.001) but not with use of a suction evacuating electrocautery hand piece (n = 4, p = 0.103). Total particle counts were also increased during use of the powered drill (n = 8, p < 0.001).
Risk from visible droplets during mandible and midface fixation is low. However, significant increases in aerosolized particles were measured after electrocautery use and during powered drilling. Aerosol dispersion is significantly decreased with the use of a smoke evacuating electrocautery hand piece.
COVID-19 大流行引发了人们对医疗程序传播风险的担忧，尤其是在头颈部进行手术修复面部骨折等操作时。本研究旨在量化下颌骨和中面部开放式固定过程中的气溶胶和液滴产生，并测量烟雾抽吸式电外科手件对空气传播颗粒的减少作用。
使用 0.1%荧光溶液对两个新鲜冷冻尸体标本的双侧下颌骨和中面部软组织进行浸润。在每个部位均通过口腔前庭入路进行手术固定。在紫外线-A（UV-A）光下，在蓝色背景下测量手术部位的医生胸部、面罩和距离每个手术部位最远 198.12 厘米（6.5 英尺）处的飞沫飞溅。使用光学颗粒计数器测量气溶胶产生。
下颌骨或中面部固定的任何试验均未观察到可见的飞沫污染。与基线相比，每次使用标准电外科（n=4，p<0.001）后，0.300-10.000 μm 的总气溶胶化颗粒计数均增加，但使用抽吸式电外科手件（n=4，p=0.103）时未增加。使用动力钻头时（n=8，p<0.001），总颗粒计数也增加了。
下颌骨和中面部固定过程中可见飞沫的风险较低。然而，电外科使用后和使用动力钻头时，测量到气溶胶化颗粒显著增加。使用烟雾抽吸式电外科手件可显著减少气溶胶分散。
