{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T23:55:20Z","timestamp":1769298920518,"version":"3.49.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T00:00:00Z","timestamp":1589846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Cadaver simulation series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Dedicated surgical laboratory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>After instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebrider\u2010assisted turbinoplasty, cold\u2010steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator. Limited droplet spread was noted with microdebrider FESS (2 droplets, &lt;1\u00a0mm in size, within 10\u00a0cm), drilling of the sphenoid rostrum with a diamond burr (8, &lt;1\u00a0mm, 12\u00a0cm), and drilling of the frontal beak with a cutting burr (5, &lt;1\u00a0mm, 9\u00a0cm); however, the use of concurrent suction while drilling resulted in no droplets or splatter. The control condition of external activation of the drill resulted in gross contamination (11, 2\u00a0cm, 13\u00a0cm).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results indicate that there is very little droplet generation from routine rhinologic procedures. The droplet generation from drilling was mitigated with the use of concurrent suction. Extreme caution should be used to avoid activating powered instrumentation outside of the nasal cavity, which was found to cause droplet contamination.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599820929274","type":"journal-article","created":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T04:01:40Z","timestamp":1589860900000},"page":"145-150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID\u201019\u00a0Pandemic"],"prefix":"10.1002","volume":"163","author":[{"given":"Dhruv","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kolin E.","family":"Rubel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taha Z.","family":"Shipchandler","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur W.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Cedars Sinai Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas S.","family":"Higgins","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery University of Louisville Louisville Kentucky USA"},{"name":"Rhinology, Sinus &amp; Skull Base, Kentuckiana Ear, Nose, and Throat Louisville Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah J.","family":"Burgin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan Y.","family":"Ting","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa A.","family":"Illing","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,5,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2020.02.018"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2001737"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28672"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4939-2438-7_1"},{"key":"e_1_2_8_6_1","article-title":"Airborne or droplet precautions for health workers treating COVID\u201019 [published online April 16, 2020]?","author":"Bahl P","year":"2020","journal-title":"J Infect Dis"},{"key":"e_1_2_8_7_1","unstructured":"American Academy of Otolaryngology\u2013Head and Neck Surgery. Otolaryngologists and the COVID\u201019 pandemic. Published2020. Accessed April 25 2020.https:\/\/www.entnet.org\/content\/otolaryngologists\u2010and\u2010covid\u201019\u2010pandemic"},{"key":"e_1_2_8_8_1","unstructured":"American Academy of Otolaryngology\u2013Head and Neck Surgery.Academy supports CMS offers specific nasal policy. Published2020. Accessed April 25 2020.https:\/\/www.entnet.org\/content\/academy\u2010supports\u2010cms\u2010offers\u2010specific\u2010nasal\u2010policy"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/v11100940"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2342-11-8"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24502"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyaa125"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0035797"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0056278"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro.2016.81"},{"key":"e_1_2_8_16_1","unstructured":"World Health Organization (WHO).Rational use of personal protective equipment for coronavirus disease (COVID\u201019) and considerations during severe shortages: interim guidance. Published2020. 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