Variation in aerosol generation by surgical modality during oropharyngeal and laryngeal surgery

The objectives were to determine the surgical modality with the lowest aerosol and droplets generated by commonly used modalities in oropharyngeal and laryngeal surgery.

A simulation of oropharyngeal and laryngeal surgery was set up using fresh sheep heads. Four common surgical modalities were utilized: cold steel, electrocautery, coblation, and microdebrider. The resultant aerosol generated was evaluated using two measurement modalities at two key positions in the theater. (1) DustTrak Pro Aerosol Monitor was used to measure the concentration of particles. (2) Fluorescein dye coated on the oropharynx and larynx, and the resultant scatter on paper.

Electrocautery and coblation produced statistically significant increases in the concentration of aerosols (p < .001). Microdebrider and cold steel instrumentation produced the least aerosols. No measurable fluorescein droplets were noted for all four modalities.

Electrocautery and coblation produced higher concentrations of aerosols. Mitigation factors should be considered with instruments with increased aerosolization. These modalities show low droplet-related infection risk.