Side-by-side lacrimal intubation threader and method

• US 20100179468A1
• Filed: 01/09/2009
• Published: 07/15/2010
• Est. Priority Date: 01/09/2009
• Status: Active Grant

• Current Assignee: Bruce B Becker
• Original Assignee: Bruce B Becker
• Inventors: Becker, Bruce B.
• Granted Patent: US 8,235,932 B2
• Time in Patent Office: Days
• US Class Current: 604/8
• CPC Class Codes: A61F 9/00772 Apparatus for restoration of tear ducts
• CPC Class Codes: A61M 31/00 Devices for introducing or retaining media, e.g. remedies, in cavities of the body A61M25/00 takes precedence ; introducing or retaining ophthalmic products into the ocular cavities A61F9/0008

Abstract

A device to facilitate insertion or threading of a flexible silicone intubation stent into the lacrimal drainage system of a patient. The device has an oblong hollow semi-rigid probe having the flexible stent releasably secured to its blunted distal end. The probe and stent are oriented in a side-by-side configuration and inserted endwise through the punctal opening, down through the nasolacrimal duct and into the nasal cavity. The flexible stent is detached from the distal end of the probe, and the probe withdrawn, leaving the stent in place. The flexible stent can be temporarily secured to the distal end of the probe through a number of means. One preferred way is to friction fit a resilient distal aperture of the stent upon the distal end of the probe and occlude the probe'"'"'s distal opening. The stent is detached by injecting a pressurized fluid through the channel of the probe thereby forcing the distal end of the stent to pop off. The proximal extremity of the stent is secured in the patient by an integrated or separate punctal anchor.

Claims

1. A method for placing a stent in a patient'"'"'s nasolacrimal duct which comprises the steps of:

selecting an elongated semirigid tubular probe and an elongated flexible stent;

wherein said probe has a proximal end and a distal end;

wherein said stent has a proximal extremity and a distal extremity;

wherein said distal extremity is detachably secured to said distal end; and

,

wherein said probe and said stent are oriented in a side-by-side configuration;

pushing said distal end and said distal extremity through a patient'"'"'s punctum, canaliculus, lacrimal sac, nasolacrimal duct and into the nasal cavity;

detaching said distal extremity from said distal end while said distal end is located in said cavity;

proximally withdrawing said probe while leaving said distal extremity in said cavity; and

,

placing a punctal anchor associated with said proximal extremity within said patient'"'"'s punctum.

2. The method of claim 1, wherein method further comprises:

said probe having an internal channel, and a first opening to said channel near said proximal end; and

a second opening to said channel near said distal end; and

,

wherein said stent occludes said second opening of said channel.

3. The method of claim 2, wherein said second opening comprises an axial hole extending through an endwall of said probe to said channel.

4. The method of claim 2, wherein said second opening comprises at least one radial hole extending through a sidewall of said probe to said channel.

5. The method of claim 1, wherein said selecting an elongated flexible stent further comprises:

choosing said stent to be tubular; and

,

wherein said distal extremity is open, and shaped and dimensioned to snugly fit over said distal end of said probe.

6. The method of claim 2, wherein said detaching comprises:

injecting a fluid into said channel at a pressure sufficient to overcome a force detachably securing said distal extremity to said distal end.

7. The method of claim 2, wherein said detaching comprises:

inserting a rod into said channel and contacting said distal extremity at a pressure sufficient to overcome a force detachably securing said distal extremity to said distal end.

8. The method of claim 1, wherein said selecting comprises:

determining a given length for said stent, wherein said determining comprises measuring a distance from said punctum to said nasal cavity;

wherein said measuring comprises;

inserting a graduated probe through said punctum to said nasal cavity;

confirming a distal end of said graduated probe is located in said nasal cavity, and,

identifying a graduation mark on said graduated probe closest to the punctal opening.

9. The method of claim 2, which further comprises:

stiffening said probe prior to said pushing;

wherein said stiffening comprises;

engaging said channel with an oblong rod having a first flexural rigidity which is more rigid than a second flexural rigidity of said stent.

10. The method of claim 1, wherein said selecting of said probe comprises:

choosing said probe to have at least one radial hole near said distal end of said probe and wherein said distal extremity engages said hole.

11. The method of claim 10, wherein said detaching comprises pushing a stylet into said channel to cut said stent.

12. The method of claim 1, wherein said method is practiced in absence of retrieving a portion of said stent out the naris.

13. The method of claim 1, wherein said method is practiced in absence of visualizing said stent within said nasal cavity.

14. The method of claim 1, wherein said method is practiced in absence of shortening said stent in vivo.

15. The method of claim 1, wherein said placing a punctal anchor occurs during said pushing step.

16. The method of claim 1, wherein said method further comprises:

confirming that the distal end is located in said nasal cavity;

wherein said confirming comprises;

injecting a tracing fluid through the probe; and

recovering traces of said fluid in said nasal cavity.

17. The method of claim 1, which further comprises injecting medication into said system through said probe.

18. A method for stenting a passageway formed by dacryocystorhinostomy (“

DCR”

) which comprises the steps of;

selecting an elongated tubular probe and an elongated flexible stent;

wherein said probe has an open proximal end and an open distal end, and defines an internal channel; and

,

wherein said stent has a proximal extremity and a distal extremity; and

,

wherein said distal extremity is detachably secured to said distal end;

pushing said probe carrying said stent through said passageway and into the nasal cavity;

confirming that the distal end of said probe is located in said nasal cavity;

detaching said distal extemity from said distal end;

proximally withdrawing said probe while leaving said stent in place; and

,

placing a punctal anchor associated with a proximal extremity of said stent within said patient'"'"'s punctum.

19. A multi-functional surgical tool for the treatment of nasolacrimal obstruction, stenosis or damage which comprises:

a first elongated semirigid tubular probe having proximal and distal ends;

an elongated stent having proximal and distal extremities;

wherein said distal extremity is releasably secured to said distal end;

wherein said probe and said stent are oriented in a side-by-side configuration;

a punctal anchor associated with said proximal extremity of said stent; and

,

wherein said anchor is sized and shaped to intimately and oversizedly engage said punctum.

20. The tool of claim 19, wherein:

said probe is shaped and dimensioned to define an internal channel;

said probe has a first opening to said channel near said proximal end; and

a second opening to said channel near said distal end; and

,

wherein said stent occludes said second opening of said channel.

21. The tool of claim 20, wherein said second opening comprises an axial hole.

22. The tool of claim 20, wherein said second opening comprises a radial hole.

23. The tool of claim 20, wherein said second opening comprises a pair of radial holes extending through a sidewall of said probe to said channel.

24. The tool of claim 19, wherein said stent has a distal aperture shaped and dimensioned to snugly and releasably engaged by said distal end to form a friction fit.

25. The tool of claim 19, wherein said probe has a distal opening shaped and dimensioned to snugly and releasably engaged by said distal extremity to form a friction fit.

26. The tool of claim 19, which further comprises a first connector at a proximal end of said probe adapted to releasably connect to a pressurized fluid source.

27. The tool of claim 26, wherein said source emits an amount of fluid at a pressure sufficient to overcome a static friction bond between said stent and said probe.

28. The tool of claim 20, which further comprises a first rod diametrically sized to engage said channel of said probe.

29. The tool of claim 28, wherein said rod dimensioned to contact a portion of said stent occluding said second opening.

30. The tool of claim 29, wherein said rod has distal cutting surface oriented to cut said stent through axial movement of said rod with respect to said probe.

31. The tool of claim 19, wherein:

said probe has a first length;

said stent has a second length shorter than said first length; and

,

wherein said second length is between about 10 millimeters and about 100 millimeters.

32. The tool of claim 19, wherein said probe has a maximum cross-sectional dimension of between about 0.014 inch and about 0.060 inch.

33. The tool of claim 19, wherein said probe further comprises graduation marking on an outer surface portion located at a range of distances from said distal end corresponding to a common range of anatomical distances between a punctum and a nasal floor.

34. The tool of claim 19, wherein:

said probe has a first flexural rigidity allowing it to be introduced into a patient'"'"'s nasolacrimal duct through one of said patient'"'"'s canaliculi by pushing on portions of said probe located proximal to said one of said patient'"'"'s canaliculi; and

,

said stent having a second flexural rigidity less rigid than said first rigidity.

35. The tool of claim 19, wherein said anchor has radial disuniformity shaped and dimensioned to rest against a medial sidewall of said probe, thereby minimizing a lateral dimension of the probe and stent oriented in said side-by-side configuration.

36. A multi-functional surgical tool for the treatment of nasolacrimal obstruction, stenosis or damage which comprises:

a first elongated semirigid tubular probe having proximal and distal ends, and defining an internal channel;

said probe being sized and having a first flexural rigidity to be introduced into a patient'"'"'s nasolacrimal duct through one of said patient'"'"'s canaliculi by pushing on portions of said probe located proximal to said one of said patient'"'"'s canaliculi;

an elongated stent having proximal and distal extremities;

said stent having a second flexural rigidity;

wherein said second rigidity is less rigid than said first rigidity;

means for detachably securing said distal extemity to said distal end; and

,

an anchor sized to intimately and oversizedly engage said punctum.