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Updated: Nov 19, 2025
Endaural Endoscopic Atticoantrotomy Retrograde Mastoidectomy using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
Droplet and bone dust contamination from high-speed drilling during mastoidectomy
Anne L Markey1, Samuel C Leong2,3, Casey Vaughan1
1Liverpool Head and Neck Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool University Hospitals Foundation Trust, Liverpool, UK.
Objectives:
The aim of this study was to examine contamination from otolaryngologic procedures involving high-speed drilling, specifically mastoid surgery, and to assess the adequacy of PPE in such procedures.
Design And Setting:
Mastoid surgery was simulated in a dry laboratory using a plastic temporal bone, microscope and handheld drill with irrigation and suction. Comparisons of distance of droplet and bone dust contamination and surgeon contamination were made under differing conditions. Irrigation speed, use of microscope and drill burr size and type were compared.
Main Outcome Measures:
Measurement of the distance of field contamination while performing simulated mastoidectomy and location of surgeon contamination.
Results:
There was a greater distance field contamination and surgeon contamination without the use of the microscope. Contamination was reduced by using a smaller drill burr and by using a diamond burr when compared to a cutting burr. The use of goggles and a face mask provided good protection for the surgeon. However, the microscope alone may provide sufficient protection to negate the need for goggles.
Conclusions:
While the risks of performing mastoid surgery during the coronavirus pandemic cannot be completely removed, they can be mitigated. Such factors include using the microscope for all drilling, using smaller size drill burrs and creating a safe zone around the operating table.
Insights
Minimizing contamination during mastoid surgery is possible. Using the microscope, smaller drill burrs, and personal protective equipment (PPE) significantly reduces droplet and bone dust spread, enhancing surgical safety.
Area of Science:
- Otolaryngology
- Surgical Safety
- Infection Control
Background:
- High-speed drilling in otolaryngologic procedures, particularly mastoid surgery, poses a risk of aerosol and particle generation.
- Assessing the effectiveness of personal protective equipment (PPE) is crucial for surgeon safety during these procedures.
Purpose of the Study:
- To evaluate contamination spread during simulated mastoid surgery.
- To determine the adequacy of PPE in mitigating airborne particles and droplet contamination.
Main Methods:
- Simulated mastoidectomy performed in a dry laboratory using a plastic temporal bone model.
- Drill parameters (irrigation speed, burr size/type) and microscope use were varied.
- Distances of droplet and bone dust contamination, as well as surgeon contamination, were measured.
Main Results:
- Absence of microscope use led to increased field and surgeon contamination.
- Smaller and diamond burrs reduced contamination compared to cutting burrs.
- Goggles and face masks offered significant surgeon protection; microscope use alone may suffice.
Conclusions:
- Contamination risks in mastoid surgery can be mitigated through specific measures.
- Recommendations include consistent microscope utilization, employing smaller drill burrs, and establishing a safe operating zone.
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