Reducing the risks of Endoscopic Sino-Nasal surgery in the C
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Many powered instruments used in routine sinonasal surgery are regarded as an aerosol-generating procedure (AGP). High-speed drilling is associated with increased risk aerosol production but suction reduces the spread.

This study by Clinical Otolaryngology aimed to assess how different instrument settings may affect detectable droplet spread and the patterns of aerosolized droplet spread during simulated sinonasal surgery with powered instrumentation in order to identify mitigation strategies.

Simulation series using a 3D printed sinonasal model was utilized. Fluorescein droplet spread was assessed following microdebriding and drilling of fluorescein-soaked grapes and bones respectively.

--There were no observable fluorescein droplets or splatter in the measured surgical field after microdebridement of nasal polyps at a specific irrigation rate and suction pressure.

--Droplet splatter occurred when suction pressure was reduced; simulating a surgical condition where there was excessive fluid in the nasal cavity irrigation.

--Drilling with either coarse diamond or cutting burr resulted in detectable droplets.

--Greater droplet spread was observed when drilling within the anterior nasal cavity. The addition of a suction catheter reduces droplet spread when drilling.

-- Activation of the microdebrider when there is excess fluid accumulating in the nasal cavity resulted in detectable droplet spread.

Conclusively, high-speed drilling is a high-risk AGP especially when drilling in the anterior nasal cavity, but the addition of suction reduces detectable droplet spread outside the nasal cavity.