Devices and Methods for Minimally Invasive Access to Sinuses and Treatment of Sinusitis

• US 20110105849A1
• Filed: 01/04/2011
• Published: 05/05/2011
• Est. Priority Date: 07/21/2009
• Status: Active Grant

• Current Assignee: Leonard V. Covello
• Original Assignee: Leonard V. Covello
• Inventors: Covello, Leonard V.
• Granted Patent: US 9,247,950 B2
• Time in Patent Office: Days
• US Class Current: 600/206
• CPC Class Codes: A61B 17/24 for use in the oral cavity, larynx, bronchial passages or nose for medical inspection of cavities or tubes in the body A61B1/00; Tongue scrapers
• CPC Class Codes: A61B 17/295 combined with cutting implements
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 2017/320048 Balloon dissectors
• CPC Class Codes: A61B 2090/0817 Spatulas or spatula like extensions
• CPC Class Codes: A61B 90/08 Accessories or related features not otherwise provided for
• CPC Class Codes: A61M 2205/04 implanted
• CPC Class Codes: A61M 2210/0681 Sinus (maxillaris)
• CPC Class Codes: A61M 25/1002 characterised by balloon shape A61M25/1006, A61M25/1009 take precedence
• CPC Class Codes: A61M 29/02 Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

The present invention provides minimally invasive devices and methods for accessing the sinuses and their surrounding structures for surgery and other treatments. The anterior ethmoid and maxillary sinuses are accessed and treated under minimal anesthesia with little or no postoperative limitation of activity or adverse symptoms. Direct visual verification of the sinuses and their natural ostia is utilized. Other paranasal sinuses may be treated by this method as well. The sinuses, in particular the maxillary and anterior ethmoid, are accessed via a direct anterior to posterior axis and the natural ostia of those sinuses is directly visualized for placement of a guide-free dilator, in the desired location within the natural ostia. That access to the maxillary ostium is accomplished by the anterior transuncinate “keyhole” approach in which a hole is punched in the uncinate process with the described devices according to the described methods. The properly placed dilator is expanded to allow drainage of the inflamed sinus and then withdrawn. An analogous ethmoid bulla “keyhole” approach and subsequent dilation are used for the anterior ethmoid sinus ostia. Pharmaceutical agents may be placed at desired locations in the sinuses using the same access technique.

Claims

1. A method of retracting the middle turbinate prior to a sinus procedure comprising:

i. advancing a middle turbinate retractor in a compressed state into the axilla of the middle meatus between the middle turbinate and the lateral wall of the nose; and

ii. expanding the middle turbinate retractor to reveal the relevant anatomy around an obstructed sinus cavity.

2. A method of retracting the middle turbinate prior to a sinus procedure comprising:

i. advancing a middle turbinate retractor in a compressed state to a position between the lateral wall of the nose and the middle turbinate and inferior to the ethmoid bulla; and

ii. expanding the middle turbinate retractor to reveal the relevant anatomy around an obstructed sinus cavity.

3. A middle turbinate retractor comprising:

i. an expandable frame having two parallel sides and a rounded portion between the two sides, said expandable frame approximating a V-shape or a U-shape;

ii. an intervening pliable metal or plastic frame between the two sides of the expandable frame which enables expansion and compression of the frame; and

iii. a pair of forceps on the inner portion of both sides of the expandable frame, wherein squeezing of the forceps results in expansion of the frame.

4. The middle turbinate retractor of claim 3, further comprising compressible pads on the outer surface of both sides of the expandable frame.

5. The middle turbinate retractor of claim 3, wherein the expandable frame expands to a width of greater than 3 mm and less than 10 mm.

6. A middle turbinate retractor comprising:

i. two rigid parallel platforms comprised of metal or plastic;

ii. a metal or plastic spring situated between the rigid platforms; and

iii. a pair of forceps on the outer surfaces of the parallel platform that allow for expansion and compression of the spring.

7. The middle turbinate retractor of claim 6, further comprising a pair of pads attached to the outer sides of the parallel platforms.

8. The middle turbinate retractor of claim 7, wherein one or both of the pads attached to the outer sides of the parallel platforms is curved to accommodate the anatomy near the middle turbinate.

9. A middle turbinate retractor comprising:

i. two arms that are capable of being expanded or compressed with respect to each other, said arms crossing each other, thereby forming an upper portion and a lower portion;

ii. a ratchet arm connected at the upper portion of each arm capable of holding the arms in place;

iii. a pair of expansion receptacles at the lower portion of each arm, whereby squeezing of said expansion receptacles results in expansion of the arms.

10. The middle turbinate retractor of claim 10, wherein one arm is configured to contact the lateral wall of the nose and the other arm is configured to abut the middle turbinate.