U.S. patent number 3,646,615 [Application Number 05/005,534] was granted by the patent office on 1972-03-07 for reinforcing element for muscles.
Invention is credited to Richard A. Ness.
United States Patent |
3,646,615 |
Ness |
March 7, 1972 |
REINFORCING ELEMENT FOR MUSCLES
Abstract
A reinforcing element for connection to a muscle to add pulling
power to the muscle. An elongated elastic body member has a head
end provided with means for anchoring the same to a portion of a
muscle, and an opposite tail end portion having transverse openings
for reception of a suture whereby the tail end portion is sewn to
the muscle in longitudinally spaced relation to the anchoring means
on the head end portion.
Inventors: |
Ness; Richard A. (Fergus Falls,
MN) |
Family
ID: |
21716354 |
Appl.
No.: |
05/005,534 |
Filed: |
January 26, 1970 |
Current U.S.
Class: |
606/1;
128/DIG.21 |
Current CPC
Class: |
A61F
2/08 (20130101); Y10S 128/21 (20130101) |
Current International
Class: |
A61F
2/08 (20060101); A61f 001/00 () |
Field of
Search: |
;128/76.5,334,335,1,DIG.21 ;3/1,13 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Claims
What is claimed is:
1. A reinforcing element for muscles comprising, an elongated
elastic body member having generally flat opposite head and tail
end portions for face-to-face engagement with longitudinally spaced
portions of a muscle, and tooth elements on said head end portion
for anchoring engagement with an adjacent portion of the muscle,
different ones of said tooth elements projecting angularly
outwardly and rearwardly in the direction of the tail end portion
from opposite surfaces of said generally flat head end portion,
said tail end portion having suture receiving openings therethrough
whereby said tail end portion may be sewn to the muscle in
longitudinally spaced relation to said head end portion.
2. The reinforcing element according to claim 1 in which said head
end portion is generally arrowhead shaped in outline, having side
edges converging forwardly to a substantially sharp point, said
side edges defining barbs for engagement with body tissue to limit
movement of said head end portion rearwardly toward said tail end
portion, the maximum width of said head end portion being greater
than that of said body member intermediate said head and tail end
portions.
3. The reinforcing element according to claim 2 in which said tail
end portion is of substantially greater width than said body member
intermediate said end portions, said tail end portion defining side
edges having parallel rear portions and smoothly recurving portions
tangent to said rear portions and adjacent side edges of said body
member.
4. The reinforcing element according to claim 1 in which said head
and tail end portions are of greater width than that of said body
member between said portions, said suture receiving openings being
arranged in a plurality of rows, said rows extending longitudinally
of said element.
5. The reinforcing element according to claim 1 in which said body
member and the head and tail end portions thereof comprises a
single piece of elastic material, said body member intermeditate
said head and tail end portions having a smaller cross-sectional
area than either of said head and tail end portions, whereby to be
more easily stretched than said head and tail end portions
longitudinally of said element.
Description
BACKGROUND OF THE INVENTION
In the correction of imbalance or inequality of operation of
muscles of a given related pair or group thereof, surgery is often
performed to strengthen the weaker muscle of the pair or group so
that the strengthened muscle exerts tension on an element
controlled thereby equal to that exerted by its related muscle on
its respective element. This is often done in the correction of
strabismus or other deviations from the normal cooperating
movements or positions of a person's eyes.
Several surgical procedures for correcting imbalance in oculorotary
muscles are presently known, such as resection, recession, tucking,
and tenotomy. In resection, a weak or underactive muscle is
tightened by resecting a section of the muscle. In recession, an
eye muscle is removed from its insertion in the eyeball and
reinserted further back on the eyeball or glove. In tucking, a
portion of the muscle is folded back on itself and, in a tenotomy,
the tendon of a muscle is severed either partially or completely at
its insertion on the globe and permitted to slide relative to the
globe. While correction is obtained by one or more of these
procedures, often several operations are necessary to obtain proper
correction, due to difficulty in determining the right amount of
tension to be applied to a muscle for the necessary correction.
Such plural surgery results in an undue amount of scar tissue, and
in substantial alteration of normal anatomy of the eye and the
extraocular eye muscles.
SUMMARY OF THE INVENTION
The primary object of this invention is the provision of means for
attachment to a muscle to implement the power exerted thereby in
moving an element connected thereto.
Another important object of this invention is the provision of a
reinforcing element which may be attached to spaced portions of a
muscle with a minimum of surgery and minimum disturbance to the
adjacent anatomy.
The reinforcing element of this invention may be used to reinforce
or aid in the pulling power of substantially any one of a person's
voluntary muscles, but is particularly adapted for use with
extraocular or oculorotary muscles, which impart movements to the
eyes and eyelids. Inasmuch as a person's eyes normally move
simultaneously in various directions, any abnormality in operation
of one or more muscles associated with one of the eyes creates any
one or more heterophoric or heterotropic conditions. A common one
of these conditions is strabismus or crossed eyes, which not only
is apt to have a psychologically disturbing effect on a patient,
but also seriously impairs the normal vision of the patient.
The reinforcing element of this invention comprises an elongated
elastic body member having a generally arrow shaped head end
portion and an opposite transversely enlarged generally flat tail
end portion. The head end portion is formed to provide a plurality
of spaced tooth elements which project angularly outwardly and
rearwardly in the direction of the tail end portion, the tail end
portion having a plurality of suture receiving openings extending
transversely therethrough. When used to reinforce an extra-ocular
muscle, such as one of the rectus muscles, the reinforcing element
is moved head end first generally rearwardly through a suitable
incision in the conjunctiva and Tenon's capsule, along the muscle
and inside the muscle sheath until the head end portion is disposed
near the apex of the recti at the rear end portion of the orbital
cavity. Reverse movement of the body member will cause the tooth
elements to become anchored in the muscle sheath and surrounding
tissue, and hold the body member against withdrawal. The body
member is then stretched to provide a predetermined tensile force,
after which the tail end portion is sewn to the muscle adjacent its
connection to the eyeball or globe. The body member, being under
predetermined tension, aids the adjacent muscle to pull the eyeball
or globe to its correct position.
The head end portion has forwardly converging side edges which
define barbs for engagement with body or muscle tissue, the barbs
cooperating with the tooth elements to anchor the head end portion
against removal from the body. The head end portion is
automatically anchored in an area where stitching the same to the
muscle could be done only under extreme difficulty, and the tail
end portion is advantageously anchored by sutures at the region of
easy accessibility.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a fragmentary generally vertical section of an orbit or
eye receiving cavity in a human skull with an eye supported therein
and the reinforcing element of this invention applied to one of the
oculorotary muscles of the eye, some parts being broken away and
some parts being shown in section;
FIG. 2 is an enlarged generally horizontal section taken
substantially on the line 2--2 of FIG. 1;
FIG. 3 is an enlarged view in plan of the reinforcing element of
this invention;
FIG. 4 is a view as seen from the line 4--4 of FIG. 3; and
FIG. 5 is a still further enlarged fragmentary detail as seen
substantially from the line 5--5 of FIG. 4.
DETAILED DESCRIPTION
In FIGS. 1 and 2, skull or bone structure 1 is shown as defining a
cavity 2, commonly known as an orbit, which contains the orb or
eyeball, indicated generally at 3. The orb 3 is shown as being
partially surrounded and supported by a cushion of fatty tissue 4,
movements of the orb 3 being controlled by the oculorotary muscles,
such as the recti and oblique muscles. In FIG. 1, the superior
rectus muscle is indicated at 5, the inferior rectus at 6, the
lateral rectus at 7, the inferior oblique at 8, and the superior
oblique at 9. In FIG. 2, a medial rectus is indicated at 10, the
optic nerve at 11, leading from the orb 3 rearwardly toward the
juncture or apex of most of the oculorotary muscles, commonly known
as the annulus of Zinn, indicated at 12 in FIG. 1. The capsule of
Tenon is shown partly in section in FIG. 2, and is indicated at 13,
the muscle sheath of the various oculorotary muscles being
indicated at 14. In addition to the above described muscles, a
levator muscle 15, for the upper eyelid, is shown in FIG. 1.
As above indicated, if any one or a given plurality of muscles of
locomotion of either eye is either weaker or stronger than the
corresponding muscles of the other eye, a muscle imbalance results
and the patient suffers from a deviation from correction vision.
Correction of the imbalance is usually effected by one of the above
described surgical procedures.
The reinforcing element of this invention, indicated in its
entirety at 16, is preferably made from an elastic rubberlike
substance which is inert to the human body. One such substance is
manufactured and sold by a Dow Corning Corp. of Midland, Michigan
under the trademark "SILASTIC" (medical grade). The element 16,
otherwise designated as an eye muscle spring, comprises an
elongated body portion having an enlarged generally pointed head
end portion 18 at one end and an enlarged tail end portion 19 at
its opposite end. With reference to FIGS. 3 and 4, it will be seen
that the head and tail end portions 18 and 19 are of considerably
greater thickness and width than the body portion 17, so as to have
greater stiffness and greater resistance to stretching than the
body portion 17. As shown, the body portion 17, and said head and
tail end portions 18 and 19 respectively, have opposite generally
flat surfaces, the head end portion 18 having side edges converging
forwardly to a substantially sharp point 20, the side edges being
serrated to provide a plurality of rearwardly pointed barbs or
teeth 21. As shown in FIG. 3, the maximum width of the head end
portion 18 is substantially greater than that of the body portion
or member 17. Further, as is shown in FIG. 4, the top surface of
the body portion 17 may be coplanar with the top surfaces of the
head and tail end portions 18 and 19 respectively, if desired. The
head end portion 18 is formed to provide a plurality of openings 22
therethrough and a like plurality of barbs 23 that project
angularly outwardly and toward the tail end portion 19, see
particularly FIGS. 3 and 4.
The tail end portion 19 has opposite side edges formed to provide
barbs or teeth 24 that are pointed generally toward the head end
portion 18, see particularly FIG. 3. Forwardly of the barbs or
teeth 24, the opposite side edges of the tail end portion 19 are
recurved, as indicated at 25, to be tangent to the adjacent side
edges of the tail end portion 19 and body portion 17, as clearly
shown in FIG. 3. Intermediate its side edges, the tail end portion
19 is provided with a plurality of longitudinally extending rows of
openings 26 therethrough for reception of sutures or like devices
by means of which the tail end portion may be secured to an
adjacent portion of muscle or other tissue.
An example of the use to which the reinforcing element of this
invention is particularly adapted, is shown in FIGS. 1 and 2, for
the purpose of correcting strabismus or crossed eyes. Assuming that
the lateral rectus 7 of the orb 3 is weaker than the medial rectus
10, so that the orb 3 deviates laterally inwardly, the reinforcing
element 16 is applied to the lateral rectus 7 to strengthen the
same or aid in its pulling power to correct the deviation. In
applying the reinforcing element or eye muscle spring 16 to the
lateral rectus 7, a transverse slit or incision 27 is made through
the capsule of Tenon 13 or sheath 14 adjacent the frontal end of
the muscle 7. Although not shown, it will be understood that the
incision 27 is made through the adjacent portion of the
conjunctiva, the incision being made after the eye has been
prepared surgically in the usual manner. The reinforcing element or
eye muscle spring 16 is then inserted through the incision 27 and,
with the use of appropriate forceps or other instrument, is slid
rearwardly between the muscle 7 and its sheath 14 until the head
end 18 is disposed adjacent the rear end of the muscle 7 or the
annulus of Zinn 12. A slight forward pull on the element 16 will
then cause the teeth 21 and barbs 23 to become embedded or fixed in
the surrounding tissue. Next, two or more sutures are placed or
stitched to the muscle 7 shortly behind where it is affixed to the
orb 3. With the use of a tension gauge, not shown, forward pull is
then exerted on the tail end portion 19 of the element 16 until the
element 16 is under the desired amount of tension to produce the
required amount of correctional deviation to the orb or eyeball 3.
While holding the reinforcing element 16 under the required
tension, the sutures are brought through adjacent ones of the
openings 26 in the tail end portion 19, and tied. The tied sutures
are indicated at 28 in FIGS. 1 and 2. The barbs or teeth 24 engage
adjacent tissue and aid the sutures 28 in holding the element 15
under proper tension. After the tail end portion 19 is thus
anchored in place, any excess material thereof between the sutures
28 and the free end of the tail end portion 19 may be cut away and
removed. The incision 27 and the adjacent slit portion of the
conjunctiva would then be closed in the usual manner, thus burying
the element or eye muscle spring 16 within the sheath of the muscle
7. When this operation is performed on an adult person under local
anesthesia, it is possible to evaluate the amount of correction
necessary before tying the sutures and removing the excess portion
of the element 16. When the operation is performed under general
anesthesia, in the case of children, a sufficient part of the tail
end portion 19 may be left for subsequent surgical correction, if
necessary. If adjustment is required, it is a relatively simple
matter to reopen the incision 27 and replace the sutures 28 in
other ones of the openings 26, so that the element 16 is placed
under less or greater tension, as needed.
From the above, it can be appreciated that, with the use of my
reinforcing or tension element 16, corrections of muscle imbalance
in various ocular muscles may be corrected with more highly
simplified surgical procedure, with a minimum of trauma and with a
minumum of alteration of the normal anatomy of the extraocular eye
muscles. While I have shown the reinforcing element 16 as being
applied to implanted in a lateral rectus muscle, it will be
appreciated that the same can be effectively applied to any of the
other oculorotary muscles including the levator muscle 15 for the
correction of ptosis, or drooping of the upper eyelid. As the
element 16 remains within the muscle, fibrous or scar tissue grows
into the openings 22 associated with the bars or teeth 23, as well
as into the unsutured openings 26, thus more completely and
permanently anchoring the head and tail end portions 18 and 19 of
the reinforcing element, so as to aid in effecting a substantially
permanent repair of the muscle.
It will be further appreciated that, while I have shown and
described the reinforcing element of this invention as being
associated with ocular muscles, the same can be used for joining or
reinforcing other muscles as well, wherein at least a portion of
the muscle is not otherwise easily accessible.
* * * * *