• Michael J Ye, Dhruv Sharma, Vincent J Campiti, Kolin E Rubel, Sarah J Burgin, Elisa A Illing, Jonathan Y Ting, Jae Hong Park, Jeffrey D Johnson, Dominic J Vernon, Hui Bae Lee, B Ryan Nesemeier, and Taha Z Shipchandler.
• Indiana University Department of Otolaryngology - Head & Neck Surgery, 1130 W Michigan St, FH 400, Indianapolis, IN 46202, USA. Electronic address: mjye@iu.edu.
• Am J Otolaryngol. 2021 Jan 1; 42 (1): 102829.

PurposeThe 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.Materials And MethodsThe 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.ResultsNo 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).ConclusionsRisk 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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