U.S. patent application number 10/961280 was filed with the patent office on 2005-05-26 for apparatus, system, and method for middle turbinate medializer.
Invention is credited to Tagge, Bryan C..
Application Number | 20050113850 10/961280 |
Document ID | / |
Family ID | 40722402 |
Filed Date | 2005-05-26 |
United States Patent
Application |
20050113850 |
Kind Code |
A1 |
Tagge, Bryan C. |
May 26, 2005 |
Apparatus, system, and method for middle turbinate medializer
Abstract
An apparatus, system, and method are disclosed for medializing
the middle turbinate following sinus surgery, thus preventing
synacheiae, granulation tissue, and other complications of the
prior art. The apparatus utilizes a fastening device configured to
attach the middle turbinate to the nasal septum, a prong comprising
a slender wand portion and a fastening module, and a handle
configured to trigger deployment of the fastening means by
activating the fastening module. The fastening device may be a
staple, rivet, glue, or another similar device.
Inventors: |
Tagge, Bryan C.; (Salt Lake
City, UT) |
Correspondence
Address: |
KUNZLER & ASSOCIATES
8 EAST BROADWAY
SALT LAKE CITY
UT
84111
US
|
Family ID: |
40722402 |
Appl. No.: |
10/961280 |
Filed: |
October 8, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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60509509 |
Oct 8, 2003 |
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Current U.S.
Class: |
606/151 ;
606/139 |
Current CPC
Class: |
A61B 17/0469 20130101;
A61B 17/068 20130101; A61B 2017/0408 20130101; A61B 17/00491
20130101; A61B 18/08 20130101; A61B 17/24 20130101; A61B 2017/00004
20130101; A61B 17/00234 20130101 |
Class at
Publication: |
606/151 ;
606/139 |
International
Class: |
A61B 017/08 |
Claims
What is claimed is:
1. A medical instrument for use in the nasal cavities, comprising:
a handle configured to control the deployment of a fastening means;
a plurality of prongs configured to enter the nasal cavity between
the middle turbinate and the outer wall of the nasal cavity the
prongs being sufficiently widely spaced to encompass the septum and
at least one middle turbinate; and a fastening module attached to
the distal end of the prong and configured to deploy a
fastener.
2. The medical instrument of claim 1, wherein the fastener is
configured of sufficient length to extend through the septum and at
least one middle turbinate.
3. The medical instrument of claim 2, wherein the fastening module
comprises a first prong and a second prong, the first prong having
a staple holder and the second prong having a staple base.
4. The medical instrument of claim 3, wherein the staple holder and
base are configured to deploy bioabsorbable staples.
5. The medical instrument of claim 2, wherein the fastening module
of at least one prong comprises a rivet shooter.
6. The medical instrument of claim 5, wherein the fastening module
of an opposite prong comprises a rivet receiver.
7. The medical instrument of claim 6, wherein the fastening module
of the prong is configured to deploy a bioabsorbable rivet.
8. The medical instrument of claim 2, wherein the fastening module
on at least one prong comprises a thread bearing module and the
fastening module on an opposite prong comprises a thread
engager.
9. The thread bearing module of claim 8, wherein the needle is
configured to pierce the turbinate and the nasal septum.
10. The medical instrument of claim 1, wherein the fastening module
of at least one prong comprises an adhesive dispenser.
11. The medical instrument of claim 10, wherein the fastening
module of at least one prong further comprises a mechanism for
compressing the turbinate e against the nasal septum during setting
of the adhesive.
12. The medical instrument of claim 11, wherein the handle is
configured to control the mechanism for compressing the turbinate
against the nasal septum.
13. The medical instrument of claim 1, wherein the fastening module
of at least one prong comprises a heatable tip configured to
cauterize the septul side of the middle turbinate.
14. The medical instrument of claim 12, wherein the fastening
module of the at least one prong further comprises a mechanism for
compressing the middle turbinate against the septum.
15. The medical instrument of claim 14, wherein the mechanism for
compressing the middle turbinate against the septum further
comprises a detachable clamp configured to remain in the nose for
sufficient time to allow the cauterized area of the turbinate to
adhere to the septum.
16. The medical instrument of claim 15, wherein the handle is
configured to control the heating of the fastening end and the
mechanism for compressing the middle turbinate against the
septum.
17. A system for medializing the middle turbinate following sinus
surgery, the system comprising: a fastener; and a medical
instrument configured to enter the nasal passage between the middle
turbinate and the outer wall of the nasal passage, the instrument
comprising: a handle configured to control the deployment of the
fastener; a plurality of prongs sufficiently widely spaced to
encompass the septum and at least one middle turbinate, having a
wand portion and a fastening module, the fastening module
configured to deploy the fastener.
18. The system of claim 17, wherein the fastener is a staple.
19. The system of claim 17, wherein the fastener is a rivet.
20. The system of claim 17, wherein the fastener is a suture.
21. The system of claim 17, wherein the fastener is composed of
bioabsorbable materal.
22. The system of claim 17, wherein the fastener is an
adhesive.
23. The system of claim 17, wherein the fastener is
cauterization.
24. The system of claim 17, further comprising an endoscopic
mechanism for viewing the placement of the fastener.
25. A method for preventing the middle turbinate from obstructing
the sinus opening following surgery, the method comprising:
providing a medical device having a fastener, a handle configured
to control the deployment of the fastener, and a plurality of
narrow prongs configured to enter the nasal passage, the plurality
of prongs sufficiently widely spaced to encompass the nasal septum
and at least one turbinate and having a fastening module configured
to attach the middle turbinate to the nasal septum; inserting the
plurality of prongs and the fastening device into the nasal
passage; activating the fastening module to deploy a fastener; and
withdrawing the medical device.
26. The method of claim 25, further comprising endoscopically
viewing the placement of the fastening means.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of and claims
priority to U.S. Provisional Patent Application No. 60/509,509
entitled "MIDDLE TURBANITE MEDIALIZER" and filed on Oct. 8, 2003
for Bryan C. Tagge.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] This invention relates to devices for surgery and more
particularly relates to devices for sinus and nasal surgery.
[0004] 2. Description of the Related Art
[0005] Adherence of the middle turbinates to the lateral wall of
the nasal cavity is a common post-operative problem following sinus
surgery performed on either the maxillary ethmoid sphenoid or
frontal sinuses. This condition, known as synechiae, blocks the
middle meatus, or opening to the sinuses, causing persistent
sinusitis and sinus disease.
[0006] Development of synechiae can require lysing to separate the
middle turbinate from the lateral nasal wall. This can be performed
under local anesthesia in a doctor's office or under general
antisthetic, using endoscopic visualization. It is, however, an
additional surgical procedure, inconvenient and often painful for
the patient.
[0007] Attempts to avoid this problem include placement of a middle
meatus spacer consisting of dissolvable or non-dissolvable packing
positioned to medialize the turbinate away from the lateral wall.
Packing, however, can foster the growth of granulation tissue as
the body's inflammatory response to a foreign body. Granulation
tissue can cause persistent sinus disease. Another medializing
technique employs sutures to secure the middle turbinates to the
septum. Placement of the sutures, however, is a time consuming and
painstaking process.
[0008] Existing surgical instruments such as bowel staplers are not
adapted to the environment of the nasal cavity. The existing septum
stapling instruments are narrow enough to enter the nasal cavity
but are not configured with attachment means of sufficient length
and otherwise appropriate to secure the middle turbinate.
[0009] From the foregoing discussion, it should be apparent that a
need exists for an apparatus, system, and method for reliably
medializing the middle turbinate away from the middle meatus with
its opening to the sinus. Beneficially, such an apparatus, system,
and method would be time effective for the physician as well as
safe and comfortable for the patient.
SUMMARY OF THE INVENTION
[0010] The present invention has been developed in response to the
present state of the art, and in particular, in response to the
problems and needs in the art that have not yet been fully solved
by currently available surgical instruments. Accordingly, the
present invention has been developed to provide an apparatus,
system, and method for medializing the middle turbinate that
overcome many or all of the above-discussed shortcomings in the
art.
[0011] The apparatus to medialize the middle turbinate is provided
with a fastening module attached to a slender prong configured to
enter the nasal cavity. The prong is attached to a handle
configured for manipulation of the prong and also configured to
activate the fastening module. The prongs are configured to be
slender enough to enter the nasal cavity, with the space between
them sufficiently wide to accommodate the septum and middle
turbinates.
[0012] The apparatus, in one embodiment, is configured to enter the
nasal cavity between the middle turbinate and lateral wall of the
cavity and staple the middle turbinate to the septum.
[0013] The apparatus is further configured, in one embodiment, to
enter the nasal cavity between the septum and middle turbinate and
staple septal membranes, or mucoperichondrial flaps following
septoplasty or removal of deformed septal bone and cartilage.
[0014] In a further embodiment, the apparatus may be configured to
rivet the middle turbinate to the septum. In another embodiment the
apparatus may be configured to deploy staples or rivets composed of
absorbable or non-absorbable material. In an additional embodiment
the apparatus may be configured to suture the middle turbinate to
the septum. In yet another embodiment the apparatus may be
configured to attach the middle turbinate to the septum via
adhesive. In one additional embodiment the apparatus may be
configured to attach the middle turbinate to the septum via
cauterization.
[0015] A system of the present invention is also presented to
medialize the middle turbinate. The system may be embodied in the
combination of the fastening module, fastening means, prongs and
activation handle of the apparatus. In particular, the system, in
one embodiment, includes a fastening module configured to staple
the middle turbinate to the septum. In a further embodiment the
system may include staples comprised of a bioabsorbable
material.
[0016] The system may further include the fastening module
configured to rivet the middle turbinate to the septum. In a
further embodiment the system may include rivets comprised of a
bioabsorbable material. The system may also include the fastening
module configured to suture the middle turbinate to the septum.
[0017] The system may further include the fastening module
configured to attach the middle turbinate to the septum via
adhesive. In a further embodiment the system may include the prong
configured with an inner extension configured to apply the adhesive
and an outer extension configured to press the middle turbinate
against the septum during setting of the adhesive.
[0018] The system may further include the fastening module
configured to attach the middle turbinate to the septum via
cauterization. In a further embodiment the system may include the
prong configured with a heatable inner extension configured perform
the cauterization and an outer extension configured to press the
middle turbinate against the septum following cauterization. In a
further embodiment the system may include a removable clamp
configured to hold the middle turbinate in place during adhesion of
the cauterization.
[0019] The system may further include equipment for direct or
remote endoscopic visualization of the placement of the fastening
means.
[0020] A method of the present invention is also presented for
medializing the middle turbinate. The method in the disclosed
embodiments substantially includes the steps necessary to carry out
the functions presented above with respect to the operation of the
described apparatus and system. In one embodiment, the method
includes preparing the patient, providing the apparatus, inserting
the prongs and fastening module of the apparatus in the nasal
cavity, activating the fastening module, placing the fastening
means, and removing the apparatus. The method also may include
placing a removable clamp to hold the turbinate against the septum
following cauterization.
[0021] In a further embodiment, the method includes direct or
remote endoscopic visualization of the procedure.
[0022] Reference throughout this specification to features,
advantages, or similar language does not imply that all of the
features and advantages that may be realized with the present
invention should be or are in any single embodiment of the
invention. Rather, language referring to the features and
advantages is understood to mean that a specific feature,
advantage, or characteristic described in connection with an
embodiment is included in at least one embodiment of the present
invention. Thus, discussion of the features and advantages, and
similar language, throughout this specification may, but do not
necessarily, refer to the same embodiment.
[0023] Furthermore, the described features, advantages, and
characteristics of the invention may be combined in any suitable
manner in one or more embodiments. One skilled in the relevant art
will recognize that the invention may be practiced without one or
more of the specific features or advantages of a particular
embodiment. In other instances, additional features and advantages
may be recognized in certain embodiments that may not be present in
all embodiments of the invention.
[0024] These features and advantages of the present invention will
become more fully apparent from the following description and
appended claims, or may be learned by the practice of the invention
as set forth hereinafter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] In order that the advantages of the invention will be
readily understood, a more particular description of the invention
briefly described above will be rendered by reference to specific
embodiments that are illustrated in the appended drawings.
Understanding that these drawings depict only typical embodiments
of the invention and are not therefore to be considered to be
limiting of its scope, the invention will be described and
explained with additional specificity and detail through the use of
the accompanying drawings, in which: In order that the manner in
which the advantages of the invention will be readily understood, a
more particular description of the invention will be rendered by
reference to specific embodiments thereof which are illustrated in
the appended drawings. Understanding that these drawings depict
only typical embodiments of the invention and are not therefore to
be considered to be limiting of its scope, the invention will be
described and explained with additional specificity and detail
through the use of the accompanying drawings in which:
[0026] FIG. 1 is perspective view of one embodiment of a middle
turbinate medializer in accordance with the present invention;
[0027] FIG. 2 is a perspective view with a cut away illustrating
the anatomy of a nasal cavity;
[0028] FIG. 3 is a perspective view with a cut away illustrating
one embodiment of a middle turbinate medializer fastening the
middle turbinates of two nasal cavities to a septum;
[0029] FIG. 4 is a perspective view with a cut away illustrating
two middle turbinates fastened to a septum;
[0030] FIG. 5 is a perspective view with a cut away illustrating a
nasal cavity with a normal septum;
[0031] FIG. 6 is a perspective view with a cut away illustrating a
nasal cavity with a deviated septum;
[0032] FIG. 7 is a perspective view with a cut away illustrating a
septum with the cartilage or bony portion removed after
septoplasty;
[0033] FIG. 8 is a perspective view with a cut away illustrating
one embodiment of a middle turbinate medializer fastening a
mucoperichondrial flap of the septum to another mucoperichondrial
flap;
[0034] FIG. 9 is a perspective view with a cut away illustrating a
nasal cavity with the mucoperichondrial flaps fastened together
with a staple.
[0035] FIG. 10 is a perspective view of an embodiment of the prongs
of a turbinate medializer configured to insert a rivet;
[0036] FIG. 11 is a perspective view of an embodiment of the prongs
of a turbinate medializer configured to apply a suture;
[0037] FIG. 12 is a perspective view of an embodiment of the prongs
of a turbinate medializer configured to apply adhesive;
[0038] FIG. 13 is a perspective view of an embodiment of the prongs
of an adhesive configured turbinate medializer inserted in a nasal
cavity;
[0039] FIG. 14 is a perspective view of an embodiment of the prongs
of an embodiment of a cauterizing turbinate medializer;
[0040] FIG. 15 is a perspective view of a nasal clamp securing the
middle turbinates during adhesion of the cauterization; and
[0041] FIG. 16 is a schematic flow chart diagram illustrating a
method in accordance with the present invention.
DETAILED DESCRIPTION OF THE INVENTION
[0042] The invention is a medical instrument, specifically, a
middle turbinate medializer. In effect, the medializer is a
modification of surgical devices used to attach body tissues
following surgery and during healing. The device of the present
invention, however, is adapted to being placed up the nose. FIG. 1
illustrates one embodiment of a middle turbinate medializer 100 of
the present invention. The medializer 100 is forked, as shown, and
comprises a handle 112, two prongs 114, and a fastening module 116
on each prong 114. The fastening module 116 in one embodiment
receives a fastener such as a staple 118 and a base 120. The staple
118 is held by one prong 114 and the base held on the other prong
114. The staple 118 is preferably configured to be sufficiently
long to pass through one middle turbinate, the septum, and the
opposite middle turbinate, in order to attach the middle turbinates
to the septum. The handle 112, activates the fastening module. In
one embodiment the placement of the staple is performed under
direct or remote endoscopic visualization.
[0043] Referring now to FIG. 2, FIG. 2 illustrates the general
anatomy of a nasal cavity 200. When sinus surgery classically known
as FESS for Functional Endoscopic Sinus Surgery is conducted, the
sinus cavity is accessed through sinus opening 202 under the middle
turbinate 204. When the surgery is completed, the middle turbinate
204 often bonds to the exterior wall of the nasal cavity 100,
blocking the sinus opening 202 and preventing proper aeration and
draining of the sinus.
[0044] To prevent this, a number of known processes are conducted,
including abrading the medial surface of the middle turbinate 204
and the septum 206 of the nose and inserting packing material
between the outer wall of the nasal cavity and the middle turbinate
204 so that the middle turbinate 204 will bond to the septum 206.
This method has disadvantages, however, including patient
discomfort and the tendency of packing to foster the growth of
granulation tissue. To improve upon this, surgeons have stitched
the two middle turbinates 204 together to the septum 206. However,
this is a time consuming task, and the stitches are required to be
removed afterward.
[0045] The present invention 100 enters into the nose with one
prong 14 inserted in each nasal cavity 200 as illustrated in FIG.
3, and is used to staple, suture, or otherwise fasten the two
middle turbinates 204 to each other and to the middle septum 206.
In some cases both middle turbinates 204 are fastened to the septum
206, though in other cases only a single middle turbinate 204 may
be fastened to the septum 206. Accordingly, when in operation, the
trigger 122 (FIG. 1) is pulled, and the staple 118 is fastened to
the base 120 through the septum 206 and middle turbinates 204, as
illustrated in FIG. 4. In one embodiment, the staple 118 or suture
is dissolvable and may be formed of an absorbable copolymer staple,
as is well known in the art.
[0046] The operation prevents lateralization of the middle
turbinate 204, with resulting adhesion and obstruction of the sinus
opening 202 which is called synechiae. Furthermore, the invention
may be used in various applications to correct nasal conditions.
One such application may include fastening together various parts
of the septum after septoplasty. Septoplasty is an operation that
alters or removes portions of the supporting structures in the
septum in order to correct defects or deformities in the nose. One
example of a defect is a deviated septum.
[0047] FIG. 5 illustrates a nasal cavity 200 with a normal septum
206. The ideal nasal septum 206 is exactly midline and divides the
left and right sides of the nose into passages of equal size. The
supporting structure 208 is usually composed of cartilage or bony
tissue and is covered by a membrane 210.
[0048] A deviated septum 206 occurs when the septum 206 is severely
shifted away from the midline as illustrated in FIG. 6. In severe
cases, a deviated septum 206 may block the nasal passage,
consequently hindering breathing through the nose and contributing
to frequent sinus infections. To treat this defect, septoplasty is
usually performed, thereby removing the problematic areas of the
supporting structure 208.
[0049] FIG. 7 illustrates a nasal cavity 200 with a portion of the
cartilage/bony structure 208 removed from the septum 206. During
the procedure, the membranes 210 are cut away from the hard tissue
208, forming mucoperichondrial flaps 210, which traditionally are
sutured together; again, a difficult, time consuming task. However,
the middle turbinate medializer 100 of the present invention may be
used to reapproximate both mucoperichondrial flaps 210 after
septoplasty.
[0050] FIG. 8 illustrates a middle turbinate medializer 100
inserted through the nostrils to fasten the mucoperichondrial flaps
210 in place to allow the septum 206 to heal and return to a
midline position. FIG. 9 depicts a staple 118 securing the flaps
210 of the septum 206. Of course, any number of staples 118 or
sutures may be introduced to the nasal cavity using the present
invention.
[0051] In a further embodiment, the medializer 100 may operate as a
rivet gun which is pressed into one or both nasal cavities 100, and
in effect, the turbinate 104 is riveted in place. FIG. 10 is a
schematic drawing depicting the fastening ends 116 of prongs 114
filled with a rivet 1002 and a rivet receiver 1004. In a further
embodiment the rivet may be comprised of bioabsorbable
material.
[0052] Sutures may be fastened in a like manner. FIG. 11 is a
schematic drawing depicting a needle, 1102, mounted perpendicularly
to a prong 114. A thread 1106 passes through a thread guide 1108,
through a needle eye 1104 and back through tread guide 108. A hole
1110 on the opposite prong 114 communicates with a bobbin assembly
1112 carrying bobbin thread 1114. In the depicted embodiment the
prongs are inserted into the nasal cavity and the needle 1104 is
activated, piercing the turbinates and septum, passing through the
hole 1110 and engaging the bobbin 1112, causing the thread 1106 to
loop and knot with the bobbin thread 1114, forming a suture. In a
further embodiment the suture is placed under direct endoscopic
visualization. In a further embodiment the suture may be performed
with bioabsorbable thread.
[0053] Various types of tissue adhesive may also be applied to
secure the turbinate to the septum. FIG. 12 depicts an embodiment
in which hollow rods 1202 deposit adhesive 1206 between the
turbinate and the septum. Pressure pads 1204 mounted on prongs 114
then close against the turbinates, holding them against the septum
while the adhesive sets. FIG. 13 depicts the device in place in a
nasal cavity 200. Adhesive 1206 flows through hollow rods 1202 to
be deposited between the middle turbinates 204 and the septum 206.
In one embodiment rods deposit the adhesive and then withdraw.
Pressure pads 1204 hold the turbinates 204 against the septum 206
during the setting of the adhesive.
[0054] Cauterization may also create an adhesion between the middle
turbinates and the septum. FIG. 14 depicts an embodiment of a
cauterization iron. Heat wands 1402 carry heat tips 1404. Pressure
pads 1204 hold the turbinate and septul tissues against the heat
tips during cauterization. In a further embodiment a temporary
clamp 1502 holds the middle turbinates against the septum while the
burns adhere as illustrated in FIG. 15.
[0055] FIG. 16 is a schematic block diagram depicting a method in
accordance with the present invention and comprising the steps of:
preparing a patient for surgery 1604; providing the turbinate
medializer device 1606; inserting the prongs of the device into the
nasal cavity 1608; activating the handle of the device to apply the
fastener to the turbinates; and withdrawing the device.
[0056] All of the above procedures may be applied to a single
turbinate or a pair of turbinates with equal effectiveness. The
present invention may be embodied in other specific forms without
departing from its spirit or essential characteristics. The
described embodiments are to be considered in all respects only as
illustrative and not restrictive.
* * * * *