U.S. patent application number 16/188181 was filed with the patent office on 2019-03-14 for devices, kits, and methods for the treatment of obstructive sleep apnea.
The applicant listed for this patent is COOK BIOTECH INCORPORATED, COOK MEDICAL TECHNOLOGIES LLC. Invention is credited to Dan Dalenberg, Patrick Melder, Arun Mohan, Christopher Nelson, Darin Schaeffer.
Application Number | 20190076291 16/188181 |
Document ID | / |
Family ID | 50336117 |
Filed Date | 2019-03-14 |
United States Patent
Application |
20190076291 |
Kind Code |
A1 |
Melder; Patrick ; et
al. |
March 14, 2019 |
Devices, Kits, and Methods for the Treatment of Obstructive Sleep
Apnea
Abstract
Devices, kits, and methods useful in the treatment of
Obstructive Sleep Apnea (OSA) are described. Example devices
include a jig, a first needle, a second needle, and a third needle.
An example jig comprises a drill guide and a tongue depressor. A
first needle comprises an elongate shaft that defines a bend and a
curve. A second needle comprises an elongate shaft that defines a
curve. A third needle comprises an elongate shaft that defines a
curve.
Inventors: |
Melder; Patrick; (Marietta,
GA) ; Schaeffer; Darin; (Bloomington, IN) ;
Nelson; Christopher; (Lafayette, IN) ; Mohan;
Arun; (Lafayette, IN) ; Dalenberg; Dan;
(Portage, MI) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
COOK MEDICAL TECHNOLOGIES LLC
COOK BIOTECH INCORPORATED |
Bloomington
West Lafayette |
IN
IN |
US
US |
|
|
Family ID: |
50336117 |
Appl. No.: |
16/188181 |
Filed: |
November 12, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
14211704 |
Mar 14, 2014 |
10123900 |
|
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16188181 |
|
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|
|
61793343 |
Mar 15, 2013 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/176 20130101;
A61B 2017/248 20130101; A61F 5/566 20130101; A61B 17/06109
20130101; A61C 1/085 20130101; A61B 17/8811 20130101; A61B
2017/00814 20130101; A61B 13/00 20130101; A61B 2017/06076 20130101;
A61B 17/8805 20130101 |
International
Class: |
A61F 5/56 20060101
A61F005/56; A61C 1/08 20060101 A61C001/08; A61B 17/06 20060101
A61B017/06; A61B 17/17 20060101 A61B017/17; A61B 13/00 20060101
A61B013/00 |
Claims
1. A jig for use on the mandible of a patient, the jig comprising:
a drill guide having a proximal end, a distal end, and a body
defining a first passageway, a second passageway, a third
passageway, a fourth passageway, and a protuberance, the
protuberance extending outward and away from the distal end of the
drill guide; and a tongue depressor releasably attached to the
drill guide, the tongue depressor having a proximal end, a distal
end, and a body that defines a track and an elongate member, the
track extending from the proximal end toward the distal end and
having a first shaft and a second shaft, the first shaft adapted to
be received by the first passageway of the drill guide, the second
shaft adapted to be received by the second passageway of the drill
guide, the elongate member extending from the track to the distal
end of the tongue depressor and having a proximal end and a distal
end, the body of the tongue depressor defining a curve between the
proximal end and the distal end of the elongate member.
2. The jig of claim 1, wherein the first passageway defined by the
drill guide has a first length; wherein the first shaft of the
track has a second length; and wherein the first length is less
than the second length.
3. The jig of claim 1, wherein the second passageway defined by the
drill guide has a first length; wherein the second shaft of the
track has a second length; and wherein the first length is less
than the second length.
4. The jig of claim 1, wherein the first passageway defined by the
drill guide has a first length; wherein the third passageway
defined by the drill guide has a second length; and wherein the
first length is greater than the second length.
5. The jig of claim 1, wherein the first passageway defined by the
drill guide has a first length; wherein the fourth passageway
defined by the drill guide has a second length; and wherein the
first length is greater than the second length.
6. The jig of claim 1, wherein the drill guide has a first length
from the proximal end of the drill guide to the distal end of the
drill guide; wherein the drill guide has a second length from the
proximal end of the drill guide to the distal end of the drill
guide; and wherein the second length is less than the first
length.
7. The jig of claim 6, wherein the body of the drill guide defines
a sloped surface on the distal end of the drill guide.
8. The jig of claim 1, wherein the body of the drill guide defines
a second protuberance and a third protuberance, each of the second
protuberance and third protuberance extending outward and away from
the distal end of the drill guide.
9. The jig of claim 1, wherein the first passageway is disposed a
first distance from the second passageway; wherein the third
passageway is disposed a second distance from the fourth
passageway; and wherein the first distance is greater than the
second distance.
10. The jig of claim 1, wherein the first passageway has a first
inside diameter; wherein the third passageway has a second inside
diameter; and wherein the first inside diameter is greater than the
second inside diameter.
11. A jig for use on the mandible of a patient, the jig comprising:
a drill guide having a proximal end, a distal end, and a body
defining a first passageway, a second passageway, a third
passageway, a fourth passageway, and a protuberance, the first
passageway having a first length, the second passageway having a
second length, the protuberance extending outward and away from the
distal end of the drill guide; and a tongue depressor releasably
attached to the drill guide, the tongue depressor having a proximal
end, a distal end, and a body that defines a track and an elongate
member, the track extending from the proximal end toward the distal
end and having a first shaft and a second shaft, the first shaft
adapted to be received by the first passageway of the drill guide
and having a third length, the second shaft adapted to be received
by the second passageway of the drill guide and having a fourth
length, the elongate member extending from the track to the distal
end of the tongue depressor and having a proximal end and a distal
end, the body of the tongue depressor defining a curve between the
proximal end and the distal end of the elongate member; wherein the
first length is less than the third length; and wherein the second
length is less than the fourth length.
12. The jig of claim 11, wherein the third passageway defined by
the drill guide has a fifth length; and wherein the first length of
the first passageway is greater than the fifth length.
13. The jig of claim 11, wherein the fourth passageway defined by
the drill guide has a fifth length; and wherein the first length of
the first passageway is greater than the fifth length.
14. The jig of claim 11, wherein the drill guide has a fifth length
from the proximal end of the drill guide to the distal end of the
drill guide; wherein the drill guide has a sixth length from the
proximal end of the drill guide to the distal end of the drill
guide; and wherein the sixth length is less than the fifth
length.
15. The jig of claim 14, wherein the body of the drill guide
defines a sloped surface on the distal end of the drill guide.
16. The jig of claim 11, wherein the body of the drill guide
defines a second protuberance and a third protuberance, each of the
second protuberance and third protuberance extending outward and
away from the distal end of the drill guide.
17. The jig of claim 11, wherein the first passageway is disposed a
first distance from the second passageway; wherein the third
passageway is disposed a second distance from the fourth
passageway; and wherein the first distance is greater than the
second distance.
18. The jig of claim 1, wherein the first passageway has a first
inside diameter; wherein the third passageway has a second inside
diameter; and wherein the first inside diameter is greater than the
second inside diameter.
19. A method of treating Obstructive Sleep Apnea in a patient, said
method comprising the steps of: placing a jig on the mandible of
said patient, the jig comprising a drill guide and a tongue
depressor releasably attached to the drill guide, the drill guide
defining a first passageway, a second passageway, a third
passageway, and a fourth passageway, the tongue depressor having a
track disposed through the first passageway and second passageway
of the drill guide; creating a first opening in the mandible of
said patient by passing a medical device through the third
passageway defined by the drill guide; creating a second opening in
the mandible of said patient by passing a medical device through
the third passageway defined by the drill guide; creating a
transverse passageway in the tongue of said patient; pulling a
sling having first and second ends through the transverse
passageway using a first needle having an elongate shaft that
defines a bend and a curve; pulling the first end of the sling
through the first opening in the mandible of said patient using a
second needle having an elongate shaft and defining a curve;
pulling the second end of the sling through the second opening in
the mandible of said patient using a third needle having an
elongate shaft and defining a curve; pulling the first and second
ends of the sling away from the mandible of said patient to advance
the tongue toward the front of the mandible of said patient; and
securing the sling to the mandible of said patient to support the
tongue.
20. The method of claim 19, wherein the first passageway is
disposed a first distance from the second passageway; wherein the
third passageway is disposed a second distance from the fourth
passageway; and wherein the first distance is greater than the
second distance.
Description
RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 14/211,704, filed on Mar. 14, 2014 and which claims the benefit
of U.S. Provisional Application No. 61/793,343, filed Mar. 15,
2013. The entire contents of each of these related applications are
hereby incorporated by reference into this disclosure.
FIELD
[0002] The disclosure relates generally to the field of medical
devices, kits containing the medical devices and other devices that
facilitate their use, and methods of treatment based on use of the
medical devices. More particularly, the disclosure relates to
medical devices, kits, and methods useful in the securement of
tissue within the body. For example, the medical devices, kits, and
methods described herein are useful in the treatment of Obstructive
Sleep Apnea (OSA).
BACKGROUND
[0003] It is sometimes necessary or desirable to secure a tissue or
portion of a tissue within the body of an animal, such as a human.
Sling devices are known in the art and can be used to affect such a
securement of tissue within the body.
[0004] Obstructive Sleep Apnea (OSA) is a clinical disorder in
which a partial or complete collapse of soft tissue occurs in the
airway during sleep. This leads to a blockage of the airway and
impaired breathing during sleep. Mild OSA can lead to fatigue,
reduced alertness following sleep, and a general reduction in
productivity for the affected individual. Severe OSA can lead to
sleep deprivation, hypoxemia, and depression.
[0005] OSA can be the result of obesity and/or diabetes. It is
believed that about 1 in every 15 Americans are affected by some
form of OSA, leading to an estimated $3.4 billion in associated
healthcare costs each year.
[0006] The art provides various options for the treatment of OSA.
Continuous Positive Airway Pressure (CPAP) machines, which supply
positive air pressure through a facemask and into the airway during
sleep, are used most frequently. The positive air pressure
maintains an open airway to prevent apnea and snoring. While these
machines are generally considered effective, they are bulky, noisy,
and cumbersome to use. Furthermore, use of these machines can be
socially awkward for some individuals.
[0007] Oral appliances that force the jaw forward to maintain an
open airway can also be used. These devices are generally
considered to be not as effective as CPAP machines, and can be
uncomfortable to use. Furthermore, these devices are frequently
ejected from the mouth during sleep, reducing their effectiveness
over the entire course of a sleeping period.
[0008] Invasive surgical procedures can also be used to treat OSA.
Various techniques have been described, including
uvulopalatopharyngoplasty (UPPP, maxillomandibular advancement
(MMA), and even tracheostomy. Surgical procedures are generally
considered to have limited and potentially short-lived
effectiveness. Furthermore, many of the procedures require
hospitalization and the use of general anesthesia. As a result,
these procedures are generally reserved for severe cases of
OSA.
[0009] The Repose.TM. System from Medtronic provides a
surgical-based tongue suspension procedure that can be performed
with or without an adjunct hyoid suspension procedure. These
suspension procedures require a surgical incision and dissection of
the neck below the mandible. Following implantation of one or more
necessary bone screws, sutures are lashed around the tongue and/or
hyoid bone and secured with surgical notes. While these procedures
offer less complicated solutions than the more invasive surgical
procedures above, they still require surgical intervention and
suffer from the drawbacks associated with surgical procedures.
Furthermore, over time, the sutures used to suspend the tongue
and/or hyoid bone may weaken under constant stress and fracture or
snap, which may limit the effectiveness of the treatment over time.
Lastly, the use of sutures in these procedures necessitates the use
of specialized knotting and securement techniques to complete the
procedure, which adds an additional opportunity for error and
failure in the device and the procedure.
[0010] Recent advancements in the art include the use of sling
devices for securing the tongue, advancing it forward toward the
chin of the patient, and permanently securing the tongue in this
new position. These new devices and methods of treatment offer
several distinct advantages, including the avoidance of invasive
surgical procedures, the use of durable and well-characterized
long-term implant materials, and a securement approach that
provides long-term stability of the tongue in its new position
following treatment.
[0011] Considering the advantages of these devices, a need exists
for ancillary medical devices, kits, and methods that provide for
their reliable and predictable placement.
BRIEF SUMMARY OF DESCRIBED EMBODIMENTS
[0012] Various ancillary medical devices useful in the placement of
sling devices used in the treatment of OSA are described and
illustrated herein. The medical devices include a jig used to
create one or more openings through the mandible of a patient at
desired positions and angles, a first needle to form a transverse
passageway through the tongue, and second and third needles to pull
the sling through the one or more passageways created in the
mandible. The jig comprises a drill guide and a tongue depressor.
The first needle comprises a handle and an elongate shaft that
defines a bend and a curve. The second needle comprises a handle
and an elongate shaft that defines a curve along its length. The
third needle comprises a handle and an elongate shaft that defines
a curve along its length.
[0013] Various kits are also described and illustrated herein. An
example kit comprises one or more of the ancillary medical devices
described herein. Another example kit comprises one or more slings
and one or more of the ancillary medical devices described
herein.
[0014] Various methods of treatment are also described herein. An
example method of treating Obstructive Sleep Apnea in a patient
comprises the following steps: creating an incision in the tissue
defining the vestibule of the lower lip of the patient; exposing
the bone of the mandible of the patient; placing a jig on the
mandible of the patient; confirming placement of the passageways
defined on the jig; creating a first opening and a second opening
through the mandible of the patient; creating a transverse
passageway in the tongue of the patient using a first needle;
advancing a second needle through the first opening created in the
mandible and through the tongue of said patient; advancing a third
needle through the second opening created in the mandible and
through the tongue; engaging a sling with the first needle; pulling
the first needle and the sling through the transverse passageway;
engaging the sling with the second needle; engaging the sling with
the third needle; pulling the second needle and the third needle
through the openings created in the mandible; pulling the tongue of
said patient forward; securing the sling; and closing the
incision.
[0015] Additional understanding of these medical devices, kits, and
methods can be obtained with review of the detailed description,
below, and the appended drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] FIG. 1 is a perspective view of a jig.
[0017] FIG. 2 is a side view of the drill guide of the jig
illustrated in FIG. 1, free of the jig.
[0018] FIG. 3 is a proximal end view of the drill guide illustrated
in FIG. 2.
[0019] FIG. 4 is a distal end view of the drill guide illustrated
in FIG. 2.
[0020] FIG. 5 is a perspective view of the tongue depressor of the
jig illustrated in FIG. 1, free of the jig.
[0021] FIG. 6 is a top view of the jig illustrated in FIG. 1
disposed on a demonstration apparatus.
[0022] FIG. 7 is a side view of the jig illustrated in FIG. 1
disposed on the display apparatus illustrated in FIG. 6.
[0023] FIG. 7A is a partial cross-sectional view of a display
apparatus and another jig disposed on the display apparatus.
[0024] FIG. 8 is a perspective view of a first needle.
[0025] FIG. 9 is another perspective view of the first needle
illustrated in FIG. 8.
[0026] FIG. 9A is a perspective view of an alternative embodiment
of the first needle.
[0027] FIG. 10 is a perspective view of a second needle.
[0028] FIG. 11 is a perspective view of a third needle.
[0029] FIG. 12 is a flowchart representation of a method of
treating Obstructive Sleep Apnea.
[0030] FIG. 13 illustrates a kit that includes a jig, a first
needle, a second needle, and a third needle according to an
embodiment.
DETAILED DESCRIPTION OF DESCRIBED EMBODIMENTS
[0031] The following detailed description and the appended drawings
describe and illustrate various medical devices, kits, and methods.
The description and drawings are provided to enable one skilled in
the art to make and use one or more medical devices, kits, and/or
to practice one or more methods. They are not intended to limit the
scope of the claims in any manner.
[0032] The term "jig" refers to a device, or components, that
receives another structure(s), device(s), or instrument(s) and
controls the location, motion, and/or the placement of the
structure(s), device(s), or instrument(s) during use. Each of the
terms "pigtail" and "curve" refers to a length of an element that
is arranged in one or more complete or partial spirals, loops,
and/or rings. Each of the terms "pigtail" and "curve" does not
require regularity in the arrangement of the one or more spirals,
loops, and/or rings and does not requires that an entire spiral,
loop, and/or ring be formed.
[0033] FIGS. 1 through 7 illustrate an embodiment of a jig 10 that
comprises a drill guide 12 and a tongue depressor 14.
[0034] Drill guide 12 has a proximal end 16, a distal end 18, and a
body 20. Body 20 defines a first opening 22, a second opening 24, a
third opening 26, a fourth opening 28, a fifth opening 30, a sixth
opening 32, a seventh opening 34, an eighth opening 36, a first
passageway 38, a second passageway 40, a third passageway 42, a
fourth passageway 44, a first protuberance 46, a second
protuberance 46', a third protuberance 46'', and a notch 47. Each
of the first opening 22, third opening 26, fifth opening 30, and
seventh opening 34 is disposed on the proximal end 16 of the drill
guide 12. Each of the second opening 24, fourth opening 28, sixth
opening 32, and eighth opening 36 is disposed on the distal end 18
of the drill guide 12. The first passageway 38 extends from the
first opening 22 to the second opening 24. The second passageway 40
extends from the third opening 26 to the fourth opening 28. The
third passageway 42 extends from the fifth opening 30 to the sixth
opening 32. The fourth passageway 44 extends from the seventh
opening 34 to the eighth opening 36.
[0035] Each of the first passageway 38 and second passageway 40 is
positioned on a first side of the drill guide 12 and each of the
third passageway 42 and fourth passageway 44 is positioned on a
second side of the drill guide 12 relative to a plane that contains
the lengthwise axis of the drill guide 12. In the embodiment
illustrated, the inside diameter of each of the first passageway 38
and the second passageway 40 is greater than the inside diameter of
each of the third passageway 42 and the fourth passageway 44.
However, alternative embodiments can include a first passageway
and/or second passageway that has an inside diameter that is
greater than, equal to, substantially equal to, or less than the
inside diameter of the third passageway and/or fourth passageway.
The first passageway 38 is disposed a first distance 38' from the
second passageway 40 and the third passageway 42 is disposed a
second distance 42' from the fourth passageway 44. The first
distance 38' is greater than the second distance 40'. Each of the
first distance 38' and the second distance 42' is measured on a
plane that is disposed orthogonal to the lengthwise axis of the
drill guide 12.
[0036] Each of the first passageway 38 and second passageway 40 is
adapted to receive a portion of tongue depressor 14, as described
below. In the embodiment illustrated, the first passageway 38 is
sized and configured to receive a portion of the first shaft 60 of
the tongue depressor 14 and the second passageway 40 is sized and
configured to receive a portion of the second shaft 62 of the
tongue depressor 14. Each of the third passageway 42 and fourth
passageway 44 is adapted to receive a portion of a drill bit, as
described below. Thus, each of the third passageway 42 and fourth
passageway 44 is sized and configured to receive a portion of a
drill bit.
[0037] In the illustrated embodiment, the first passageway 38 and
the second passageway 40 are parallel to each other and the third
passageway 42 and the fourth passageway 44 are parallel to each
other. The third passageway 42 and the fourth passageway 44 and
each have a slight upward angle (e.g., toward the first passageway
and second passageway) from the proximal end 16 to the distal end
18 of the drill guide 12. Thus, each of the third passageway 42 and
the fourth passageway 44 extend toward a plane that contains the
lengthwise axis of the drill guide 12 from the proximal end 16 to
the distal end 18 of the drill guide 12.
[0038] While the first passageway 38 has been illustrated as
disposed a first distance 38' from the second passageway 40 that is
greater than a second distance 42' separating the third passageway
42 and the fourth passageway 44, any suitable configuration of the
passageways defined by the body of a drill guide is considered
suitable. Skilled artisans will be able to select a suitable
configuration for the passageways defined by the body of a drill
guide according to a particular embodiment based on various
considerations, including the structural arrangement at a desired
point of treatment. For example, a first passageway can be disposed
from a second passageway a first distance and the third passageway
can be disposed from the fourth passageway a second distance. The
first distance can be greater than, equal to, substantially equal
to, or less than the second distance.
[0039] While the first passageway 38 and the second passageway 40
have been illustrated as parallel to each other and the third
passageway 42 and the fourth passageway 44 have been illustrated as
parallel to each other, other configurations are considered
suitable. Skilled artisans will be able to select a suitable
structural configuration for the passageways defined by a drill
guide according to a particular embodiment based on various
considerations, including the structural configuration of the
tongue depressor of a jig. For example, alternative embodiments
could include a first passageway that is not parallel to a second
passageway and/or a third passageway that is not parallel to a
fourth passageway. Example alternative configurations considered
suitable for the third passageway and fourth passageway include a
third passageway and fourth passageway that are parallel to the
lengthwise axis of the drill guide, a third passageway and/or
fourth passageway that extend toward a plane that contains the
lengthwise axis of the drill guide from the proximal end to the
distal end of the drill guide, a third passageway and/or fourth
passageway that extend away from a plane that contains the
lengthwise axis of the drill guide from the proximal end to the
distal end of the drill guide, a third passageway and/or fourth
passageway that extend toward the lengthwise axis of the drill
guide from the proximal end to the distal end of the drill guide
(e.g., each passageway is angled toward the center of the drill
guide), a third passageway and/or fourth passageway that extend
away from the lengthwise axis of the drill guide from the proximal
end to the distal end of the drill guide (e.g., each passageway is
angled away from the center of the drill guide), and any other
configuration considered suitable for a particular embodiment.
[0040] While the body 20 of the drill guide 12 has been illustrated
as defining a first passageway 38 and second passageway 40 that are
sized and configured to receive a portion of the tongue depressor
14 and a third passageway 42 and a fourth passageway 44 that are
sized and configured to receive a portion of a drill bit, any
suitable number of passageways can be defined by the body of a
drill guide and can have any suitable size and configuration.
Skilled artisans will be able to select a suitable number of
passageways to define on a drill guide according to a particular
embodiment based on various considerations, including the
structural configuration of a tongue depressor of a jig and/or the
structural arrangement at a point of treatment. Example number of
passageways considered suitable for the body of a drill guide to
define that are sized and configured to receive a portion of a
tongue depressor and/or a drill bit include one, at least one, two,
a plurality, three, four, and any other number considered suitable
for a particular embodiment. Example diameters considered suitable
include a first passageway and/or second passageway that has a
diameter that is equal to, substantially equal to, greater than, or
less than the diameter of a third passageway and/or fourth
passageway.
[0041] Each of the first protuberance 46, second protuberance 46',
and third protuberance 46'' extends outward and away from the
distal end 18 of the drill guide 12. Each of the second
protuberance 46' and third protuberance 46'' is disposed between
the third passageway 42 and the first protuberance 46. The
inclusion of one or more protuberances is considered advantageous
at least because it provides a mechanism for maintaining the
position of the drill guide and/or lower lip during use. However,
alternative embodiments can omit a first protuberance, second
protuberance, and/or third protuberance from a drill guide.
[0042] While the body 20 of the drill guide 12 has been illustrated
as defining a first protuberance, a second protuberance, and a
third protuberance, the body of a drill guide can define any
suitable number of protuberances. Skilled artisans will be able to
select a suitable number of protuberances to define on a drill
guide according to a particular embodiment based on various
considerations, including the structural arrangement at a point of
treatment. Example number of protuberances considered suitable for
the body of a drill guide to define include one, at least one, two,
a plurality, three, four, and any other number considered suitable
for a particular embodiment. Optionally, the body of a drill guide
can be formed of a first material and each protuberance included on
the drill guide can be formed of a second material that is
different from, or the same as, the first material. In these
embodiments, each protuberance can be an integral component of the
drill guide, or a separate component attached to the body of the
drill guide using any suitable method of attachment, such as using
an adhesive, or using any suitable structure, such as a friction
fit between the protuberance and a recess defined by the body of
the drill guide.
[0043] The body 20 of the drill guide 12 defines the notch 47 on
the proximal end 16 of the drill guide 12. The notch 47 extends
into the body 20 of the drill guide 12 between the first passageway
38 and the third passageway 42 and from a first side of the body 20
to a second side of the body 20. While the notch 47 has been
illustrated as extending from the first side of the drill guide 12
to the second side of the drill guide 12, alternative embodiments
can omit the inclusion of a notch, or define a notch that extends
between the first side and the second side.
[0044] The body 20 has a first length 48' and a second length 48''
that defines a sloped surface 49 on the distal end 18 of the drill
guide 12 relative to a plane that is orthogonal to the lengthwise
axis of the drill guide 12 (e.g., sloped surface 49 extends
through, and at an angle to, the lengthwise axis of the drill
guide). The first length 48' is measured from the proximal end 16
of the drill guide 12 and along the portion of the body 20 that
defines the first passageway 38 and the second passageway 40. The
second length 48'' is measured from the proximal end 16 of the
drill guide 12 and along the portion of the body 20 that defines
the third passageway 42 and the fourth passageway 44. In the
embodiment illustrated, the first length 48' is greater than the
second length 48''. Alternatively, a drill guide can define a first
length that is equal to, substantially equal to, or less than a
second length. For example, the first passageway and/or second
passageway defined by the body of a drill guide can have a length
that is greater than, equal to, substantially equal to, or less
than the length of the third passageway and/or fourth passageway
defined by the body of the drill guide.
[0045] While the body 20 of the drill guide 12 has been illustrated
as having a particular structural arraignment (e.g., that defines a
notch 47 and a sloped surface 49), the body of a drill guide can
have any suitable structural arrangement. Skilled artisans will be
able to select a suitable structural arrangement for a drill guide
according to a particular embodiment based on various
considerations, including the structural arrangement of a tongue
depressor and/or the structural arrangement at a desired point of
treatment. In alternative embodiments, the body of a drill guide
can omit the inclusion of a notch and/or sloped surface on the
distal end of the drill guide. An example alternative embodiment of
a drill guide is illustrated in FIG. 7A, and described in more
detail below.
[0046] Tongue depressor 14 has a proximal end 50, a distal end 52,
and a body 54 that defines a track 56 and an elongate member 58.
The track 56 extends from the proximal end 50 toward the distal end
52 and has a first shaft 60 and a second shaft 62. First shaft 60
has a first end 64 and a second end 66 and second shaft 62 has a
first end 68 and a second end 70. Each of the second end 66 of the
first shaft 60 and the second end 70 of the second shaft 62 is
attached to elongate member 58.
[0047] First shaft 60 is adapted to be received by the first
passageway 38 defined by the drill guide 12 and second shaft 62 is
adapted to be received by the second passageway 40 defined by the
drill guide 12. Thus, the first shaft 60 is parallel to the second
shaft 62. However, alternative embodiments can include a first
shaft and second shaft that are not parallel and that correspond to
the arrangement of the first passageway and second passageway
defined by the drill guide. The first shaft 60 is sized and
configured to be received by the first passageway 38 and the second
shaft 62 is sized and configured to be received by the second
passageway 40. In the embodiment illustrated, the first shaft 60
has a length that is greater than the length of the first
passageway 38 and the second shaft 62 has a length that is greater
than the length of the second passageway 40. The first shaft 60 has
an outside diameter 61 that is less than the inside diameter of the
first passageway 38 and second shaft 62 has an outside diameter 63
that is less than the inside diameter of the second passageway 40.
However, alternative embodiments can include a first shaft that has
an outside diameter that is greater than, equal to, or
substantially equal to the inside diameter of the first passageway
and/or second shaft that has an outside diameter that is greater
than, equal to, or substantially equal to the inside diameter of
the second passageway. In these embodiments, a friction fit can be
accomplished between the drill guide and the tongue depressor as
the tongue depressor is advanced into the drill guide such that the
tongue depressor is releasably attached to the drill guide.
[0048] The elongate member 58 extends from the track 56 to the
distal end 52 of the tongue depressor 14. The elongate member 58
has a proximal end 72 and a distal end 74 and the body 54 of the
tongue depressor 14 defines a curve 75 between the proximal end 72
and the distal end 74 of the elongate member 58. In the illustrated
embodiment, the portion of the elongate member 58 that extends from
the proximal end 72 of the elongate member 58 to the curve 75 is
disposed at an angle to, and extends away from, a plane that
contains the lengthwise axis of the first shaft 60 and the
lengthwise axis of the second shaft 62. Curve 75 extends from the
angled portion of the elongate member 58 disposed proximal to the
curve 75 and away from the plane that contains the lengthwise axis
of the first shaft 60 and the lengthwise axis of the second shaft
62. This structural arrangement corresponds to the general anatomy
of the portion of a body that is intended to be treated (e.g.,
tongue of a patient). However, other structural arrangements are
considered suitable. For example, alternative embodiments can
include an elongate member that omits the inclusion of a curve
defined between the proximal end and the distal end of the elongate
member and/or that defines a bend between the proximal end and the
distal end of the elongate member.
[0049] The portion of the elongate member 58 positioned proximal to
the curve 75 can be disposed at any suitable angle relative to a
plane that contains the lengthwise axis of the first shaft 60 and
the lengthwise axis of the second shaft 62 and the curve 75 can
have any suitable radius of curvature. Skilled artisans will be
able to select a suitable angle and radius of curvature to define
on the elongate member of a tongue depressor according to a
particular embodiment based on various considerations, including
the structural arrangement of the anatomy on which the device is
intended to be used. Example angles considered suitable include
angles between 0 degrees and 45 degrees, between about 0 degrees
and about 45 degrees, angles less than 45 degrees, angles less than
about 45 degrees, and any other angle considered suitable for a
particular embodiment.
[0050] FIGS. 6 and 7 illustrate the jig 10 disposed on a display
apparatus that is formed as a human mandible 80 and tongue 81.
While the example of a human mandible 80 and tongue 81 has been
illustrated, the medical devices, kits, and methods described
herein can be used to treat any suitable portion of the body. In
use, the first shaft 60 is passed through the first passageway 38
of the drill guide 12 and the second shaft 62 is passed through the
second passageway 40 of the drill guide 12. The elongate member 58
is disposed on the tongue 81 and the drill guide 12 is disposed on
the mandible 80 of the patient such that the lower lip is retracted
and positioned between a surface of the drill guide 12 (e.g.,
sloped surface 49) and the mandible 80. The drill guide 12 and the
tongue depressor 14 are advanced toward one another until each of
the third passageway 42 and fourth passageway 44 are disposed below
the central incisor tooth root and above the top of the lower
lip.
[0051] Optionally, one or more apertures can be defined through the
body 20 of drill guide 12 that are in communication with the first
passageway 38 and/or one or more apertures can be defined through
body 20 of drill guide 12 that are in communication with the second
passageway 40. Each aperture can include threads that are
complementary to threads of a set screw that can be disposed
through the aperture to releasably attach, or attach, the tongue
depressor 14 to the drill guide 12. For example when first shaft 60
is disposed through first passageway 38 and second shaft 62 is
disposed through the second passageway 40, a set screw can be
advanced through an aperture in communication with a passageway
until the set screw contacts the shaft of the tongue depressor to
releasably attach, or attach, the tongue depressor 14 to the drill
guide 12. This is considered advantageous at least because it
provides a mechanism for maintaining a desired position of the jig
10 during use.
[0052] While one or more apertures and one or more set screws have
been described, a tongue depressor can be releasably attached, or
attached, to a drill guide using any suitable method or structure,
and skilled artisans will be able to select suitable method and/or
structure to attach, or releasably attach, a tongue depressor to a
drill guide according to a particular embodiment based on various
considerations, including the structural arrangement of a track.
Example methods and structures considered suitable include, but are
not limited to, using snap fit configurations, using adhesives, and
any other method or structure considered suitable for a particular
application.
[0053] While the body 54 of the tongue depressor 14 has been
illustrated as defining a track 56 having a first shaft 60 and a
second shaft 62, the body of a tongue depressor can define a track
with any suitable number of shafts. Skilled artisans will be able
to select a suitable number of shafts to define on the track of a
tongue depressor according to a particular embodiment based on
various considerations, including the structural configuration of a
drill guide of a jig and/or the structural arrangement at a point
of treatment. Example number of shafts considered suitable for the
body of a tongue depressor to define include one, at least one,
two, a plurality, three, four, and any other number considered
suitable for a particular embodiment. An example alternative
embodiment of a tongue depressor is illustrated in FIG. 7A, and
described in more detail below.
[0054] While the body 54 of the tongue depressor 14 has been
illustrated as having a particular structural arrangement (e.g.,
that defines a track 56 and an elongate member 58), the body of a
tongue depressor can have any suitable structural arrangement.
Skilled artisans will be able to select a suitable structural
arrangement for a tongue depressor according to a particular
embodiment based on various considerations, including the
arrangement of a drill guide and/or the structural arrangement at a
desired point of treatment. For example, each shaft defined by a
tongue depressor can have a length that is less than, equal to, or
substantially equal to, the length of a passageway defined by a
drill guide.
[0055] Each of the drill guide 12 and tongue depressor 14 can be
formed of any suitable material, and skilled artisans will be able
to select a suitable material to form a drill guide and tongue
depressor of a jig according to a particular embodiment based on
various considerations, including the type of treatment intended to
be performed. Example materials considered suitable to form a drill
guide and/or a tongue depressor of a jig include biocompatible
materials, materials that can be made biocompatible, metals such as
stainless steel, titanium, nickel-titanium alloys (e.g., Nitinol),
polymers, Pebax (Pebax is a registered trademark of Ato Chimie
Corporation of Allee des Vosges, Courbevoie, France), nylon,
polyethylene, polyurethane, polytetrafluoroethylene (PTFE), ePTFE,
silicone, and any other material considered suitable for a
particular application. For example, a drill guide can be formed of
a first material and the tongue depressor can be formed of a second
material. The first material can be the same as, or different than,
the second material.
[0056] FIG. 7A illustrates another jig 10' disposed on a display
apparatus that is formed as a human mandible 80'. The display
apparatus illustrates the human mandible 80', the tongue 81', and
the lower lip 82'. Jig 10' is similar to jig 10 illustrated in
FIGS. 1 through 7 and described above, except as detailed below.
Reference numbers in FIG. 7A refer to the same structural element
or feature referenced by the same number in FIGS. 1 through 7,
offset by '. Thus, jig 10' comprises a drill guide 12' and a tongue
depressor 14'.
[0057] In the embodiment illustrated, the drill guide 12' omits the
inclusion of a second passageway (e.g., second passageway 40),
fourth passageway (e.g., fourth passageway 44), and a third
protuberance (e.g., third protuberance 46''). In addition,
alternative to defining a first notch (e.g., notch 47) and a sloped
surface (e.g., sloped surface 49), the body 20' of the drill guide
12' defines a protuberance 47' and a flat distal surface 49' (e.g.,
orthogonal to the lengthwise axis of the drill guide 12').
[0058] The protuberance 47' extends from the proximal end 16' of
the drill guide 12' and away from the distal end 18' of the drill
guide 12'. The drill guide 12' has a first length 48'' and a second
length 48'''. The first length 48'' extends from the proximal end
16' to the distal end 18' of the drill guide 12'. The second length
48''' extends from the proximal end of the protuberance 47' to the
distal end 18' of the drill guide 12'. In the embodiment
illustrated, the first length 48'' is less than the second length
48'''. Thus, the first passageway 38' has a length that is less
than the length of the third passageway 42'.
[0059] In the illustrated embodiment, the tongue depressor 14'
omits the inclusion of a second shaft (e.g., second shaft 62) and
includes a first shaft 60' that extends from a first end 64' to a
second end 66'. The first shaft 60' is disposed on the center of
the proximal end 72' of the elongate member 58'. However,
alternative embodiments can include a first shaft 60' that is
offset from the center of the proximal end 72' of the elongate
member 58'. The elongate member 58' of tongue depressor 14' defines
a curve 75' between the proximal end 72' and the distal end 74' of
the elongate member 58'. The curve 75' has a radius of curvature
that is less than the radius of curvature of the curve 75 defined
on the elongate member 14 illustrated in FIGS. 1, 5, 6, and 7.
[0060] In use, as illustrated in FIG. 7A, the first shaft 60' is
passed through the first passageway 38' of the drill guide 12'. The
elongate member 58' is disposed on the tongue 81' and the drill
guide 12' is disposed on the mandible 80' such that the lower lip
82' is retracted and positioned between a surface of the drill
guide 12' (flat distal surface 49') and the mandible 80'. The drill
guide 12' and the tongue depressor 14' are advanced toward one
another until the third passageway 42' is disposed below the
central incisor tooth root and above the top of the lower lip
82'.
[0061] FIGS. 8 and 9 illustrate a first needle 110 that comprises a
handle 112 and an elongate shaft 114.
[0062] Handle 112 has a first end 116 and a second end 118 and an
axial length 119 that extends from the first end 116 to the second
end 118. In the illustrated embodiment, the handle 112 has a
cylindrical cross-sectional configuration that extends from the
first end 116 to the second end 118. However, other cross-sectional
configurations are considered suitable, such as rectangular,
square, oval, cross-sectional configurations that vary along the
axial length of the handle, and any other cross-sectional
configuration considered suitable for a particular embodiment.
[0063] Elongate shaft 114 has a lengthwise axis 115, a first end
120, a tapered second end 122, and a body 124 that defines a bend
126, a curve 128, and a notch 130. The first end 120 is attached to
handle 112 such that elongate shaft 114 extends at an angle to the
axial length 119 of handle 112. The elongate shaft 114 can be
disposed at any suitable angle to the handle (e.g., substantially
90 degree angle, 90 degree angle). The first end 120 can be
attached to the handle 112 using any suitable method or structure,
such as using adhesive, threaded connections, press fit
configurations, and any other method or structure considered
suitable for a particular embodiment.
[0064] Bend 126 is defined between the first end 120 and the
tapered second end 122 of the elongate shaft 114. The bend 126 is
defined at an angle 127 relative to the lengthwise axis 115 of the
elongate shaft 112. In the illustrated embodiment, the bend 126 is
defined at a substantially 90 degree angle 127 relative to the
lengthwise axis 115. The bend 126 can be formed on elongate shaft
114 using any suitable method and/or structure. For example, the
bend 126 can be formed on elongate shaft 114 by placing the
elongate shaft 114 on a mandrel and applying a force on the portion
of the elongate shaft disposed proximal to the mandrel while
maintaining the position of the portion of the elongate shaft
disposed distal to the mandrel.
[0065] While bend 126 has been illustrated as defined at
substantially a 90 degree angle, a bend can be defined at any
suitable angle to the lengthwise axis of an elongate shaft, and
skilled artisans will be able to select a suitable angle to define
a bend relative to the lengthwise axis of an elongate shaft
according to a particular embodiment based on various
considerations, including the structural arrangement at a treatment
site. Example angles considered suitable to define a bend relative
to the lengthwise axis of an elongate shaft include, but are not
limited to, angles between about 1 degree and about 180 degrees,
between about 20 degrees and about 160 degrees, between about 45
degrees and about 135 degrees, about 90 degrees, at a substantially
90 degree angle, at a 90 degree angle, and any other angle
considered suitable for a particular application.
[0066] Curve 128 is defined distal to the bend 126, extends about
the lengthwise axis 115 (e.g., orbits the lengthwise axis), and
defines an outside diameter 129 measured along a plane that is
orthogonal to the lengthwise axis 115 of the elongate shaft 114. In
the illustrated embodiment, the curve 128 extends about lengthwise
axis 115 of the elongate shaft 114 about 270 degrees such that the
tapered second end 122 of the elongate shaft 114 and a portion of
curve 128 is disposed on a plane that extends through, and at an
angle to, the lengthwise axis 115 of elongate shaft 114. The curve
128 is configured such that it defines a pigtail configuration. In
the embodiment illustrated, the curve 128 extends from a location
distal to the bend 126 in a counter-clockwise direction relative to
the lengthwise axis 115 of the elongate shaft 114 to a location
proximal to the notch 130.
[0067] While the a portion of curve 128 has been illustrated as
disposed on a plane that extends at an angle to the lengthwise axis
115 of elongate shaft 114, a curve can have any suitable structural
arrangement. Skilled artisans will be able to select a suitable
structural arrangement for a curve according to a particular
embodiment based on various considerations, including the
structural arrangement at a treatment site. Example structural
arrangements considered suitable for a curve include, but are not
limited to, positioning an entire curve on a plane that extends
orthogonal to the lengthwise axis of an elongate shaft, positioning
a portion of a curve on a plane that extends orthogonal to the
lengthwise axis of an elongate shaft, positioning an entire curve
and a tapered distal end on a plane that extends orthogonal to the
lengthwise axis of an elongate shaft, positioning a portion of a
curve and a tapered distal end on a plane that extends orthogonal
to the lengthwise axis of an elongate shaft, positioning a portion,
or the entirety, of a curve on a plane that extends through, and at
an angle (e.g., between about 1 degree and about 180 degrees,
between about 45 degrees and about 135 degrees, at a 45 degree
angle, at about a 45 degree angle, at a substantially 45 degree
angle, at a 90 degree angle, at a substantially 90 degree angle, at
about a 90 degree angle) to the lengthwise axis of an elongate
shaft, and any other structural arrangement considered suitable for
a particular application. Alternative to a curve extending about
the lengthwise axis 115 of the elongate shaft 114 about 270
degrees, a curve can extend about the lengthwise axis of an
elongate shaft any suitable distance, such as distances that define
a curve that extends about the lengthwise axis of an elongate shaft
equal to, substantially equal to, or about 45 degrees, 90 degrees,
135 degrees, 180 degrees, 225 degrees, 270 degrees, 315 degrees,
360 degrees, and any other distance considered suitable for a
particular embodiment.
[0068] Curve 128 can define any suitable outside diameter 129
measured along a plane that is orthogonal to the lengthwise axis
115 of elongate shaft 114. Skilled artisans will be able to select
a suitable outside diameter for a curve according to a particular
embodiment based on various considerations, including the width of
the tongue of a patient. Example diameters considered suitable to
define a curve include, but are not limited to, diameters that are
between about 1% and 100% of the width of an average human tongue,
diameters that are between about 10% and 90% of the width of an
average human tongue, diameters that are between about 20% and 80%
of the width of an average human tongue, diameters that are between
about 30% and 70% of the width of an average human tongue,
diameters that are between about 40% and 60% of the width of an
average human tongue, diameters that are about 50% of the width of
an average human tongue, diameters that are 50% of the width of an
average human tongue, diameters that are substantially 50% of the
width of an average human tongue, diameters that are between about
0.25 inches and about 4.0 inches, diameters that are between about
0.50 inches and about 3.0 inches, diameters that are between about
0.75 inches and about 2.0 inches, diameters that are between about
1.0 inch and about 1.75 inches, diameters that are about 1.0 inch,
diameters that are 1.0 inch, diameters that are substantially 1.0
inch, and any other diameter considered suitable for a particular
application. As used herein, the width of an average human tongue
is equal to, substantially equal to, or about 2.0 inches.
[0069] Notch 130 is disposed between the curve 128 and the tapered
second end 122 of the elongate shaft 114 and extends into the body
124 of the elongate shaft 114 toward the lengthwise axis 115 of the
elongate shaft 114 (e.g., center of the body 124 of the elongate
shaft) and toward the tapered second end 122. The notch 130 extends
into the body 124 a first length and toward the tapered second end
122 a second length. In the illustrated embodiment, the second
length is greater than the first length. However, alternative
embodiments can include a notch that has a first length that is
greater than, equal to, or substantially equal to, the second
length.
[0070] The handle 112 and the elongate shaft 114 of a first needle
110 can be formed of any suitable material, and skilled artisans
will be able to select a suitable material for a handle and an
elongate shaft of a needle according to a particular embodiment
based on various considerations, including the treatment intended
to be performed. Example materials considered suitable to form a
handle and an elongate shaft of a needle include biocompatible
materials, materials that can be made biocompatible, metals such as
stainless steel, titanium, nickel-titanium alloys (e.g., Nitinol),
polymers, Pebax (Pebax is a registered trademark of Ato Chimie
Corporation of Allee des Vosges, Courbevoie, France), nylon,
polyethylene, polyurethane, polytetrafluoroethylene (PTFE), ePTFE,
silicone, and any other material considered suitable for a
particular application. For example, the handle of a needle can be
formed of a first material and the elongate shaft of the needle can
be formed of a second material. The first material can be the same
as, or different than, the second material. For example, the first
material can be a polymer and the second material can be a
metal.
[0071] FIG. 9A illustrates an alternative embodiment of a first
needle 110'. First needle 110' is similar to first needle 110
illustrated in FIGS. 8 and 9 and described above, except as
detailed below. Reference numbers in FIG. 9A refer to the same
structural element or feature referenced by the same number in
FIGS. 8 and 9, offset by '. Thus, first needle 110' comprises a
handle 112' and an elongate shaft 114'.
[0072] In the illustrated embodiment, the curve 128' is defined
distal to the bend 126', extends about the lengthwise axis 115'
(e.g., orbits the lengthwise axis), and defines an outside diameter
129' measured along a plane that is orthogonal to the lengthwise
axis 115' of the elongate shaft 114'. In the illustrated
embodiment, the curve 128' extends about lengthwise axis 115' of
the elongate shaft 114' about 180 degrees such that the tapered
second end 122' of the elongate shaft 114' and a portion of curve
128' is disposed on a plane that extends orthogonal to the
lengthwise axis 115' of elongate shaft 114'. The curve 128' is
configured such that it defines a pigtail configuration. In
addition, in the embodiment illustrated, the curve 128' extends
from a location distal to the bend 126' in a clockwise direction
relative to the lengthwise axis 115' of the elongate shaft 114' to
a location proximal to the notch 130'.
[0073] FIG. 10 illustrates a second needle 210. Second needle 210
is similar to first needle 110 illustrated in FIGS. 8 and 9 and
described above, except as detailed below. Reference numbers in
FIG. 10 refer to the same structural element or feature referenced
by the same number in FIGS. 8 and 9, offset by 100. Thus, second
needle 210 has a handle 212 and an elongate shaft 214.
[0074] In the embodiment illustrated, the handle 212 has a first
end 216, a second end 218, and an axial length 219 that extends
from the first end 216 to the second end 218. The cross-sectional
configuration of handle 212 varies along the axial length 219 of
the handle 212 and defines an ergonomical grip with two finger
flanges.
[0075] Elongate shaft 214 has a first end 220, a tapered second end
222, a length 223 that extends from the first end 220 to the second
end 222, and a body 224. First end 220 is attached to handle 212
using any suitable method or structure, such as those described
herein. For example, the elongate shaft 214 can define a bend
between the first end 220 and the second end 222 that is disposed
within a recess defined by the handle 212 and an adhesive can be
applied within the recess to achieve attachment of the elongate
shaft 214 to the handle 212.
[0076] Alternative to defining a bend (e.g., bend 126), a curve
(e.g., curve 128), and a notch (e.g., notch 130) as illustrated in
FIGS. 8 and 9, the body 224 of the elongate shaft 214 defines a
curve 226 and a notch 228. The curve 226 is defined along a portion
of the length 223 of elongate shaft 214 that extends from the
tapered second end 222 and toward the first end 220. Alternatively,
a curve 226 defined by an elongate shaft 214 can be defined along
the entire length of the elongate shaft 214 (e.g., from the first
end 220 to the tapered second end 222, from the handle 212 to the
tapered second end 222).
[0077] Notch 228 is disposed between the first end 220 and the
tapered second end 222 and extends into body 224 toward the
lengthwise axis of the elongate shaft 214 (e.g., center of the body
224 of the elongate shaft 214) and toward the tapered second end
222. The notch 228 extends into the body 224 a first length and
toward the tapered second end 222 a second length. In the
illustrated embodiment, the second length is greater than the first
length.
[0078] FIG. 11 illustrates a third needle 210'. Third needle 210'
is similar to the second needle 210 illustrated in FIG. 10 and
described above, except as detailed below. Reference numbers in
FIG. 11 refer to the same structural element or feature referenced
by the same number in FIG. 10, offset by '. Thus, third needle 210'
has a handle 212' and an elongate shaft 214'.
[0079] In the illustrated embodiment, the curve 226' is defined
along the entire length of the elongate shaft 214' that extends
from the handle 212' (e.g., from the handle 212' to the tapered
second end 222').
[0080] While the first needle 110, second needle 210, and third
needle 210' have been illustrated as having an elongate shaft with
a tapered second end and a circular cross-sectional configuration,
the elongate shaft of a needle can have any suitable structural
configuration. Skilled artisans will be able to select a suitable
cross-sectional configuration for the elongate shaft of a needle
according to a particular embodiment based on various
considerations, including the treatment intended to be performed.
Example cross-sectional configurations considered suitable include
rectangular, square, oval, cross-sectional configurations that vary
along the axial length of the elongate shaft, and any other
cross-sectional configuration considered suitable for a particular
embodiment. Alternative to an elongate shaft having a tapered
second end, an elongate shaft can have a second end that is curved,
that is adapted to be atraumatic, and any other configuration
considered suitable for a particular embodiment.
[0081] FIG. 12 is a flowchart representation of a method 300 of
treating Obstructive Sleep Apnea (OSA) in a patient using a sling.
Performance of the method results in securement of the tongue of an
animal, such as a human, via the sling being looped through the
tongue and secured to the mandible. With the tongue secured in this
manner, it is expected that the individual being treated will
experience fewer and/or reduced symptoms associated with OSA.
[0082] An initial step 302 comprises creating an incision in the
tissue that defines the vestibule of the lower lip of the patient
to expose the mandible (e.g., mentum of the mandible). The incision
can be made at any suitable location that allows for the drilling
of holes, as described below. Any suitable technique and tool can
be used to perform this step, including a scalpel or other cutting
instrument. Alternatively, an incision can be made below the tissue
that defines the vestibule of the lower lip of the patient to
expose the mandible (e.g., below the chin, above the chin).
[0083] An optional step comprises exposing the treatment site
(e.g., the tissue forming the vestibule of the lower lip of the
patient). This optional step can be accomplished prior to step 302
and using any suitable tool, such as a Jenning's mouth retractor.
Another optional step comprises administering a medication to the
patient. This optional step can be accomplished prior to step 302
and using any suitable medication (e.g., lidocaine, epinephrine).
For example, the lower lip of the patient can be grasped and the
sub-labial region of the gingiva groove of the mandible can be
infiltrated with 1% lidocaine with 1:100,000 epinephrine. Another
optional step comprises exposing the bone of the mandible. This
optional step can be accomplished by moving the tissue located
adjacent the incision made in step 302. Any suitable tool can be
used to expose the mandible and move the tissue (e.g., freer
elevator, forceps). Another optional step comprises preserving a
cuff of gingiva to facilitate closure of the incision.
[0084] Another step 304 comprises placing a jig, such as jig 10, on
the mandible of the patient. This step can be accomplished by
contacting a protuberance of the drill guide (e.g., first
protuberance 46, second protuberance 46', third protuberance 46'')
to the mandible, or the tissue disposed over the mandible, and the
tongue depressor to the tongue. An optional step comprises placing
a distally directed force (e.g., toward tongue of patient) on the
drill guide and a proximally directed force (e.g., toward drill
guide) on the tongue depressor such that the drill guide and tongue
depressor are advanced toward one another. Another optional step
comprises retracting the lower lip of the patient (e.g., such that
it is disposed below a passageway and/or protuberance defined by
the drill guide, such that the interior surface of the lower lip is
directed toward a surface of the drill guide). Use of a jig, such
as jig 10, is considered advantageous at least because it is
expected to reduce risk of error in the positioning of the openings
intended to be formed through the mandible. Another optional step
comprises releasably attaching the tongue depressor to the drill
guide. In embodiments that include one or more set screws that are
adapted to contact a shaft of a tongue depressor, another optional
step comprises advancing each set screw into and through the
aperture defined by the drill guide until the set screw contacts
the shaft.
[0085] While method 300 has been described as being completed with
jig 10, any suitable device(s) can be used to complete the methods,
steps, optional steps, and/or alternative steps described herein.
Skilled artisans will be able to select a suitable device(s) to
complete a method, step, optional step, and/or alternative step
according to a particular embodiment based on various
considerations, including the treatment intended to be performed.
Example devices considered suitable to complete the methods, steps,
optional steps, and/or alternative steps described herein include
jig 10, jig 10', first needle 110, first needle 110', second needle
210, third needle 210', and any other device considered suitable
for a particular application.
[0086] Another step 306 comprises confirming placement of the third
passageway and fourth passageway defined by the drill guide. This
step is considered advantageous to avoid creating openings in the
mandible in undesirable locations. For example, this step can be
accomplished by confirming that each of the third passageway and
fourth passageway is disposed below the root of the central incisor
tooth (e.g., each of the third passageway and fourth passageway is
below the exposed incisor at least, or greater than, two times the
height of the exposed incisor). In embodiments in which the jig
omits the inclusion of a fourth passageway (e.g., jig 10'), this
step 306 can alternatively comprise confirming placement of the
third passageway.
[0087] Another step 308 comprises creating a first opening and a
second opening in the mandible of the patient, such as at the
mental protuberance or chin. This step can be accomplished using
any suitable technique, including standard drilling techniques and
at any suitable location on the mandible, such as in the paramedian
position. For example, the following optional steps can be
completed. An optional step comprises advancing a drill bit having
any suitable diameter (e.g., 3 millimeter drill bit) through the
third passageway defined by the drill guide and through the outer
and inner cortices of the mandible. Another optional step comprises
withdrawing the drill bit from the third passageway. Another
optional step comprises advancing the drill bit through the fourth
passageway defined by the drill guide and through the outer and
inner cortices of the mandible. Another optional step comprises
withdrawing the drill bit from the fourth passageway. It is
considered advantageous for the third passageway and the fourth
passageway to be as close together as possible while retaining
distinctness of the openings that are created to facilitate
tightening of the sling, as described below. Optionally, step 308
can be completed in two separate steps. A first step comprises
creating a first opening in the mandible of a patient and a second
step comprises creating a second passageway in the mandible of the
patient. In embodiments in which the jig omits the inclusion of a
fourth passageway (e.g., jig 10'), step 308 can alternatively
comprise creating a first opening in the mandible of the patient
and can be accomplished as described above. When a single opening
is created in the mandible of the patient the drill bit can have an
outside diameter that is greater than 3 millimeters such that both
the second needle and the through needle can be advanced through
the opening.
[0088] An optional step comprises introducing a placement rod in
the third passageway and through the first opening formed in the
mandible after it has been created such that movement of the jig 10
is eliminated, or reduced, relative to the fourth passageway and
each of the fourth passageway and the subsequently created second
opening is positioned at a desired location relative to the third
passageway and first opening. Another optional step comprises
withdrawing the placement rod from the third passageway and the
first opening formed in the mandible. Another optional step
comprises removing the jig from the mandible. This optional step
can be accomplished by applying a proximally directed force on the
drill guide and/or a distally directed force on the tongue
depressor such that the drill guide is advanced away from the
tongue depressor. Subsequently, the jig can be removed from the
mandible and the tongue. In embodiments that include one or more
set screws that are adapted to contact a shaft of a tongue
depressor, another optional step comprises advancing each set screw
out of and through the aperture defined by the drill guide until
the set screw if free of contact with the shaft.
[0089] Another step 310 comprises creating a passageway in the
tongue of a patient such that the passageway lies on a plane that
is transverse to the longitudinal axis of the tongue. Any suitable
technique and tool can be used to perform this step, including a
needle (e.g., first needle 110, first needle 110') or other
tunneling instrument. In embodiments in which the first needle is
used to create the transverse passageway in the tongue, an optional
step comprises penetrating the tissue of the tongue (e.g., the
dorsal tongue posterior to the circumvallate papillae). Another
optional step comprises rotating the first needle to create the
passageway in the tongue. Depending on the device used, this
optional step can be accomplished by rotating the first needle in a
clockwise or counter-clockwise direction.
[0090] Another step 312 comprises advancing the second needle 210
through the first of the two openings in the mandible such that the
second needle extends through the entire opening and through a
portion of the tongue of the patient, with a portion of the device
(e.g., first end 220) disposed outside of the opening and adjacent
the chin and another portion of the device (e.g., tapered second
end 222) disposed outside of the opening and adjacent the tongue.
For example, the second needle 210 can be advanced such that it is
advanced through one of the openings (e.g., left dorsal puncture
site) of the transverse passageway created in step 310. An optional
step comprises applying a proximally directed force on the first
needle to advance the tongue toward the mandible. This optional
step can be completed subsequent to step 310 and/or concurrent with
step 312.
[0091] In embodiments in which the jig omits the inclusion of a
fourth passageway (e.g., jig 10'), step 312 can alternatively
comprise advancing the second needle 210 through the opening
created in the mandible such that the second needle extends through
the entire opening and through a first portion of the tongue of the
patient, with a portion of the device (e.g., first end 220)
disposed outside of the opening and adjacent the chin and another
portion of the device (e.g., tapered second end 222) disposed
outside of the opening and adjacent the tongue. For example, the
second needle 210 can be advanced such that it is advanced through
one of the openings (e.g., left dorsal puncture site) of the
transverse passageway created in step 310.
[0092] Another step 314 comprises advancing the third needle 210'
through the second of the two openings in the mandible such that
the third needle 210' extends through the entire second opening and
through a portion of the tongue of the patient, with a portion of
the device (e.g., first end 220') disposed outside of the second
opening and adjacent the chin and another portion of the device
(e.g., tapered second end 222') disposed outside of the second
opening and adjacent the tongue. For example, the third needle 210'
can be advanced such that it is advanced through one of the
openings (e.g., right dorsal puncture site) of the transverse
passageway created in step 310. An optional step comprises applying
a proximally directed force on the first needle to advance the
tongue toward the mandible. This optional step can be completed
subsequent to step 312 and/or concurrent with step 314.
[0093] In embodiments in which the jig omits the inclusion of a
fourth passageway (e.g., jig 10'), step 314 can alternatively
comprise advancing the third needle 210' through the opening
created in the mandible such that the third needle 210' extends
through the entire opening and through a second portion of the
tongue of the patient, different from the first portion, with a
portion of the device (e.g., first end 220') disposed outside of
the opening and adjacent the chin and another portion of the device
(e.g., tapered second end 222') disposed outside of the opening and
adjacent the tongue. For example, the third needle 210' can be
advanced such that it is advanced through one of the openings
(e.g., right dorsal puncture site) of the transverse passageway
created in step 310.
[0094] Another step 316 comprises passing the first needle through
the transverse passageway in the tongue such that the distal end
and the notch of the elongate shaft are disposed beyond one end of
the passageway and outside of the tongue and a portion of the
elongate shaft that is disposed proximal to the bend is disposed
beyond another end of the passageway and outside of the tongue.
Optionally, this step can be omitted in methods in which the first
needle has not been removed from the first passageway after the
first passageway is been created (e.g., first needle has not been
removed after step 310).
[0095] Another step 318 comprises engaging a sling with the notch
of the first needle that is disposed through the transverse
passageway in the tongue such that the sling is releasably attached
to the first needle. Any suitable sling can be used with the
devices, methods, and kits described herein. Example slings are
described in copending U.S. Nonprovisional application Ser. No.
13/550,065, filed Jul. 16, 2012. The entire contents of this
application are hereby incorporated by reference into this
disclosure by reference.
[0096] Another step 320 comprises pulling the first needle and the
attached sling through the transverse passageway in the tongue
until the sling is disposed in the transverse passageway with a
portion of the sling extending beyond one end of the passageway and
outside of the tongue and another portion of the sling extending
beyond another end of the passageway and outside of the tongue.
This step can be accomplished by applying a rotational force to the
handle of the first needle such that the first needle rotates about
the lengthwise axis the elongate shaft (e.g., counter-clockwise
direction, clockwise direction).
[0097] Another step 322 comprises engaging a first portion of the
sling, such as the first end of the sling, with the notch 228 of
the tongue-adjacent end of the second needle 210 disposed in the
first of the two openings in the mandible such that a pulling force
applied to the second needle 210 will result in the first end of
the sling being pulled along with the second needle 210 through the
tongue and the first opening in the mandible.
[0098] Another step 324 comprises engaging a second portion of the
sling, such as the second end of the sling, with the notch 228'
tongue-adjacent end of the third needle 210' disposed in the second
of the two openings in the mandible such that a pulling force
applied to the third needle 210' will result in the second end of
the sling being pulled along with the third needle 210' through the
tongue and the second opening in the mandible.
[0099] Another step 326 comprises pulling the second needle 210 and
third needle 210' and the first and second ends of the sling
through the respective openings in the mandible until each end of
the sling has exited the respective opening. It is considered
advantageous to perform this step by pulling each of the needles
simultaneously and at substantially the same rate with
substantially the same force, but the needles can be pulled
sequentially or with different rates and/or forces if considered
desirable and/or necessary. Performance of this step results in
each of the ends of the sling being pulled through one of the first
and second openings in the tongue. In embodiments in which the jig
omits the inclusion of a fourth passageway (e.g., jig 10'), step
326 can alternatively comprise pulling the second needle 210 and
third needle 210' and the first and second ends of the sling
through the opening in the mandible until each end of the sling has
exited the opening.
[0100] Another step 328 comprises pulling the tongue toward the
front of the mouth or mandible by pulling on one or both of the
second needle 210 and third needle 210' and/or one or both of the
first and second ends of the sling. An optional step comprises
removing the sling from the second needle 210. Another optional
step comprises removing the sling from the third needle 210'.
[0101] Another step 330 comprises securing the sling. This can be
accomplished once a desired configuration of the tongue has been
achieved and by securing the sling to itself, a tissue, or bone,
such as the mandible, to support the tongue in the new position.
For example, an optional step can comprise tying the first end of
the sling with the second end of the sling to achieve securement of
the sling in place. Another step can comprise sealing the openings
in the mandible, such as with bone cement or other suitable
composition and/or technique.
[0102] Another step 332 comprises closing the incision. This step
can be accomplished using any suitable technique or tool (e.g.,
using sutures). Optionally, this step can be accomplished using a
preserved cuff of gingiva to facilitate closure of the
incision.
[0103] FIG. 13 illustrates a kit 400 that comprises a jig 402
according to an embodiment, such as jig 10 (e.g., drill guide 12,
tongue depressor 14); a first needle 404 according to an
embodiment, such as first needle 110; a second needle 406 according
to an embodiment, such as second needle 210; a third needle 408
according to an embodiment, such as third needle 210'; a first
sling 410 according to an embodiment; a second sling 412 according
to an embodiment; a third sling 414 according to an embodiment; a
plurality of vials of bone cement 416; an injection device 418 to
introduce the bone cement into an opening; and instructions for use
420.
[0104] Optionally a kit can include one or more placement rods that
comprise an elongate shaft that has a first end and a second end
and a length disposed between the first end and the second end.
Each placement rod has a length that is equal to, substantially
equal to, or greater than the combined length of the third
passageway and the length of the first opening created in the
mandible or the combined length of the fourth passageway and the
length of the second opening created in the mandible. Optionally a
kit can include one or more set screws that are adapted to be
passed through an aperture defined by the drill guide. Optionally,
a kit can include one or more drill bits (e.g., 3 millimeter drill
bit, drill bit having an outside diameter greater than 3
millimeters) to create one or more openings in the mandible of the
patient. Optionally, a kit can include a bone cement mixer.
[0105] While a single delivery system jig 402, a first needle 404,
a second needle 406, a third needle 408, a first sling 410, a
second sling 412, and a third sling 414, a plurality of vials of
bone cement 416, and an injection device 418 have been illustrated
in kit 400, any suitable type and/or number of jigs, needles,
slings, vials of bone cement, and injection devices can be included
in kit 400. Skilled artisans will be able to select a suitable
number of jigs, needles, slings, vials of bone cement, and
injection devices according to a particular embodiment based on
various considerations, including the intended recipient of the
kit. Example numbers of jigs, needles, slings, vials of bone
cement, and injection devices considered suitable to include in a
kit include, but are not limited to, one, at least one, two, a
plurality, three, four and any other number considered suitable for
a particular application. Example devices considered suitable to
include in a kit include jig 10, jig 10', first needle 110, first
needle 110', second needle 210, third needle 210', any suitable
sling, any suitable delivery device, any suitable mixing device,
and any other device considered suitable for a particular
embodiment.
[0106] The foregoing detailed description refers to medical
devices, kits containing the medical devices and other devices that
facilitate their use, and methods of treatment based on use of the
medical devices and includes the best mode for practicing the
invention. The description and the appended drawings illustrating
the described devices, methods, and kits are intended only to
provide examples and not to limit the scope of the claims in any
manner.
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