Aerosol and Droplet Generation from Open Rhinoplasty: Surgical Risk in the Pandemic Era

Overview

The COVID-19 pandemic raised concern that head and neck operations, including cosmetic facial surgery, could spread infection through droplets or aerosols. The authors set out to measure which rhinoplasty steps actually generate them. Noses of human anatomic specimens were infiltrated with 0.1 percent fluorescein, a dye visible under ultraviolet light, and particles were counted with an optical particle sizer during each technique.

Sections of note

• Design: laboratory study on human anatomic specimens, not living patients.
• Techniques tested: opening the skin and soft tissue envelope, monopolar electrocautery, endonasal rasping, endonasal osteotomy and percutaneous osteotomy.
• Negative control for comparison: anterior rhinoscopy.
• No visible droplet contamination was observed under ultraviolet light for any technique tested.
• Total aerosols in the 0.300 to 10.000 micrometer range increased after monopolar electrocautery, p less than 0.001, and endonasal rasp, p equal to 0.003.
• Opening the soft tissue envelope, endonasal osteotomy and percutaneous osteotomy produced no detectable aerosol increase, p greater than 0.15.

What it means for a patient

• Most steps of a rhinoplasty did not produce measurable airborne particles in this model.
• The two steps that did, electric cautery and rasping bone through the nose, both involve heat or high speed friction.
• This was a cadaveric model with dye, not live patients, and it measured particles rather than any actual virus.
• The findings inform protective equipment decisions for the surgical team. They say nothing about the patient's own risk or outcome.

Why this paper matters

Elective facial surgery was suspended widely during the pandemic on the assumption that nasal procedures were high risk. Measuring which specific steps generate aerosols allows precautions to be targeted rather than applied to the whole operation. Whether aerosol counts translate to actual transmission risk was not measured.

Terms

• Aerosol: particles small enough to stay suspended in air for a period.
• Droplet: a larger particle that falls quickly onto nearby surfaces.
• Fluorescein: a dye that glows under ultraviolet light, used to make spatter visible.
• Monopolar electrocautery: an instrument that uses electric current to cut and seal tissue.
• Endonasal rasping: filing bone through an incision inside the nose.
• Osteotomy: a planned cut or controlled fracture of bone.