Oral and maxillofacial surgery in patients with suspected or confirmed COVID-19, presents a high risk of exposure and cross contamination to the operative room personnel. We designed, simulated and implemented a continue negative pressure operative field barrier to provide an additional layer of protection, using standard equipment readily available in most operative rooms during oral and maxillofacial procedures.
Salivary and mucosal secretions act as a reservoir for high concentrations of COVID-19.
Oral and maxillofacial procedures are known to generate aerosols (High speed drilling, Irrigation).
Continuous negative pressure operative barrier may decrease the exposure of COVID-19 during oral maxillofacial surgery.
Salivary and mucosal secretions have been described as a reservoir for high concentrations of COVID-19, even in asymptomatic patients [ , ]. Oral and maxillofacial surgery in patients with suspected or confirmed COVID-19 present a high risk of exposure to operating room personnel [ ], since many procedures are known to generate aerosols during interventions performed inside the oral cavity or in close proximity to the oral and nasal mucosa [ ]. Therefore, our team designed a continuous negative pressure operative field barrier using standard equipment readily available in most operating rooms to provide an additional layer of protection to all staff during oral and maxillofacial procedures.
Material and methods
A simulation of the continuous negative pressure environment was designed and develop in order to validate the concept and proof that continuous negative pressure would clear aerosolized particles from the surgical field (Video 1). After obtaining informed consent, a patient with a symptomatic left maxillary sinus lesion, pending COVID-19 testing, was scheduled to undergo time-sensitive enucleation and curettage with buccal fat pad advancement. The patient was nasally intubated, followed by a standard preparation and drape of the surgical field. A Bookwalter retractor table post was mounted to the side of the operating room bed. The oval ring was placed over the operative site, securing it to the table using the extension bar and adjusted for the convenience of the surgical team. Self-adhesive sterile drapes (3M Steri-drapes, commonly known as 1000 drapes) were placed circumferentially around the oval ring in order to create a drop-like curtain from the edge of the ring down to the surgical field ( Fig. 1 ). A transparent sterile plastic sheet, serving as an operative field barrier for droplets and debris, was draped over and secured to the oval ring using non-penetrating towel clamps. In order to create a continuous negative pressure environment under the operative field barrier, a commercially available surgical waste manager with a filtered smoke evacuator was utilized (Neptune 3®, Stryker Corporation, Kalamazoo, MI). A 7/8-inch tubing secured to the flex bar with the tip facing the surgical field was connected to the 7/8-inch smoke evacuator port ( Fig. 2 ). Surgery was performed with no complication ( Fig. 3 ) (Video 1); patient was transferred to the recovery area and discharge home the same day.