Method and apparatus for treatment of air way obstructions

• US 5,738,114 A
• Filed: 05/22/1996
• Issued: 04/14/1998
• Est. Priority Date: 02/23/1996
• Status: Expired due to Fees

• Current Assignee: Sonmus Medical Technologies Incorporated
• Original Assignee: Somnus Medical Technologies, Inc. (Olympus Corporation)
• Inventors: Edwards, Stuart D.
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US08/651,378
• Time in Patent Office: 692 Days
• Field of Search: 606/41, 606/42, 606/45-50, 604/21, 604/22, 128/898
• US Class Current: 128/898
• 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 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/1815 using microwaves
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00814 Surgery of the tongue, e.g. glossoplasty
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00101 low, i.e. thermally insulating
• CPC Class Codes: A61B 2018/00196 reciprocating lengthwise
• CPC Class Codes: A61B 2018/00261 arranged in a line
• CPC Class Codes: A61B 2018/00636 Sensing and controlling the application of energy
• CPC Class Codes: A61B 2018/00666 using a threshold value
• CPC Class Codes: A61B 2018/00678 upper
• CPC Class Codes: A61B 2018/00708 switching the power on or off
• CPC Class Codes: A61B 2018/00744 : Fluid flow
• CPC Class Codes: A61B 2018/00773 : Sensed parameters
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61M 2025/0096 : being laterally outward extensions or tools, e.g. hooks or fibres
• CPC Class Codes: A61N 1/06 : for high-frequency therapy
• CPC Class Codes: A61N 1/403 : for thermotherapy, e.g. hyperthermia
• CPC Class Codes: A61N 5/04 : Radiators for near-field treatment
• CPC Class Codes: A61N 5/045 : specially adapted for treatment inside the body

Abstract

A method for reducing a volume of a tongue in an oral cavity provides an ablation apparatus. The ablation apparatus including a source of electromagnetic energy and one or more electromagnetic energy delivery electrodes coupled to the electromagnetic energy source. A distal end of the ablation apparatus is introduced into the oral cavity. The distal end of the ablation apparatus is positioned outside of an oral cavity gag response zone. At least one electrode is introduced into an interior of the tongue when the distal end of the ablation apparatus is positioned outside of the oral cavity gag response zone. A sufficient amount of electromagnetic energy is delivered from the electrode into the interior of the tongue to debulk a section of the tongue without damaging the hypoglossal nerve. The electrode is then removed from the interior of the tongue.

Claims

1. A method for reducing a volume of a tongue in an oral cavity, comprising:

providing an ablation apparatus including a source of electromagnetic energy and an enrgy delivery device comprising one or more electromagnetic energy delivery electrodes coupled to the electromagnetic energy source;

introducing a distal end of the ablation apparatus into the oral cavity;

positioning the distal end of the ablation apparatus outside of an oral cavity gag response zone;

advancing at least one electrode into an interior of the tongue;

delivering a sufficient amount of electromagnetic energy from the electrode into the interior of the tongue to debulk a section of the tongue without permanently damaging a main branch of a hypoglossal nerve; and

retracting the electrode from the interior of the tongue.

2. The method of claim 1, wherein the energy source is an RF source and the energy delivery device is an RF electrode.

3. The method of claim 1, wherein the energy source is a microwave source and the energy delivery device is a microwave antenna.

4. The method of claim 1, wherein the electrode is advanced into an interior of the tongue through a ventral surface of the tongue.

5. The method of claim 1, wherein the electrode is advanced into an interior of the tongue through an inferior dorsal surface of the tongue.

6. The method of claim 1, wherein the electrode is advanced into an interior of the tongue through a dorsum surface of the tongue.

7. The method of claim 1, wherein the electrode is advanced into an interior of the tongue through a tip of the tongue.

8. The method of claim 1, wherein two or more electrodes are advanced into a different interior area of the tongue.

9. The method of claim 1, wherein two or more electrodes are introduced through a different surface site of the tongue.

10. The method of claim 1, wherein the ablation apparatus further comprises:

a catheter including a lumen, wherein the electrode is deployed from the catheter lumen into an interior of the tongue.

11. The method of claim 1, wherein the catheter further comprises:

a cooling element.

12. The method of claim 11, wherein the cooling element comprises a cooling channel in an interior of the catheter, the cooling channel receiving a cooling medium and circulating the cooling medium through the interior of the catheter.

13. The method of claim 12, further comprising:

cooling a surface of the tongue while an electrode ablates an interior section of the tongue.

14. The method of claim 10, wherein the catheter is introduced into the oral cavity and one or more electrodes are introduced into an interior of the tongue through one of an inferior dorsal surface of the tongue, a dorsum surface of the tongue, or a tip of the tongue.

15. The method of claim 10, wherein the catheter is introduced into the oral cavity and one or more electrodes are introduced into an interior of the tongue through a ventral surface of the tongue.

16. The method of claim 1, further comprising:

providing an imaging apparatus.

17. The method of claim 16, wherein the imaging apparatus is an ultrasound device.

18. The method of claim 16, further comprising:

imaging the tongue prior to debulking the tongue.

19. The method of claim 16, further comprising:

imaging the tongue after debulking the tongue.

20. A method for treating airway obstructions, comprising:

providing an ablation apparatus including a source of electromagnetic energy and an energy delivery drive comprising one or more electromagnetic energy delivery electrodes coupled to the electromagnetic energy source;

introducing a distal end of the ablation apparatus into an oral cavity;

determining an oral cavity gag response zone;

positioning the distal end of the ablation apparatus outside of the oral cavity gag response zone;

advancing at least one electrode into an interior of a tongue when the distal end of the ablation apparatus is positioned outsied of the oral cavity gag response zone;

delivering sufficient electromagnetic energy form the electrode into the interior of the tounge to debulk an interior section without permanently damaging a main branch of a hypoglossal nerve; and

retracting the energy delivery device form the interior of the tongue.

21. The method of claim 20, wherein the electrode is advanced into an interior of the tongue through a ventral surface of the tongue.

22. The method of claim 20, wherein the electrode is advanced into an interior of the tongue through an inferior dorsal surface of the tongue.

23. The method of claim 20, wherein the electrode is advanced into an interior of the tongue through a dorsum surface of the tongue.

24. The method of claim 20, wherein the electrode is advanced into an interior of the tongue through a tip of the tongue.

25. The method of claim 20, wherein the ablation apparatus further comprises:

a catheter including a lumen, wherein the electrode is deployed from the catheter lumen into an interior of the tongue.

26. The method of claim 25, wherein the catheter is introduced into the oral cavity and one or more electrodes are introduced into an interior of the tongue through one of an inferior dorsal surface of the tongue, a dorsum surface of the tongue, or a tip of the tongue.

27. The method of claim 25, wherein the catheter is introduced into the oral cavity and one or more electrodes are introduced into an interior of the tongue through a ventral surface of the tongue.

28. The method of claim 20, wherein the energy source is an RF source and the energy delivery device is an RF electrode.

29. The method of claim 20, wherein the tongue is debulked sufficiently to increase a cross-sectional area of the airway passage.

30. The method of claim 20, further comprising:

providing an imaging apparatus.

31. The method of claim 30, further comprising:

imaging the tongue prior to debulking.

32. The method of claim 30, further comprising:

imaging the tongue after debulking.

33. A method for treating airway obstructions, comprising:

providing an ablation apparatus including a source of electromagnetic energy and an energy delivery device comprising one or more electromagnetic energy delivery electrodes coupled to the electromagnetic energy source;

positioning a distal end of the ablation apparatus outside of an oral cavity gag response zone;

advancing at least one electrode into a lingual tonsil;

delivering sufficient electromagnetic energy from the electrode into an interior of the lingual tonsil and debulk the lingual tonsil when a distal end of the ablation apparatus is positioned outside of an oral cavity gag response zone; and

retracting the electrode from the lingual tonsil.

34. The method of claim 33, wherein the energy source is an RF source and the energy delivery device is an RF electrode.

35. The method of claim 33, wherein one or more electrodes are advanced into a different section of the lingual tonsil.

36. The method of claim 33, further comprising:

providing an imaging apparatus.

37. The method of claim 36, wherein the imaging apparatus is an ultrasound device.

38. The method of claim 36, further comprising:

imaging the lingual tonsil prior to debulking.

39. The method of claim 36, further comprising:

imaging the lingual tonsil after debulking.

40. A method for treating airway obstructions, comprising:

providing an ablation apparatus including a catheter with a catheter tissue interface surface, an electrode at least partially positioned in an interior of the catheter and advanceable and retractable to and from the catheter into an interior of a body structure, and a means for cooling the catheter tissue interface surface;

positioning a distal end of the ablation apparatus outside of an oral cavity gag response zone;

advancing the electrode from the interior of the catheter through a body structure external surface into the interior of the body structure when a distal end of the ablation apparatus is positioned outside of an oral cavity gag response zone;

delivering sufficient energy from the electrode into the interior of the body structure to ablate a portion of the interior of the body structure;

cooling the catheter tissue interface surface sufficiently to reduce a swelling of the body structure external surface; and

retracting the electrode from the interior of the body structure.

41. The method of claim 40, wherein the body structure is the tongue.

42. The method of claim 41, wherein the external body surface is a dorsum surface of the tongue.

43. The method of claim 41, wherein the exterior body surface is a ventral surface of the tongue.

44. The method of claim 41, wherein the exterior surface is an inferior dorsal surface of the tongue.

45. The method of claim 41, wherein sufficient electromagnetic energy is delivered to an interior of the tongue to ablate at least a portion of the interior of tongue with a minimal ablation of a surface of the tongue.

46. The method of claim 45, wherein a taste buds on the surface of the tongue are not ablated.

47. The method of claim 40, wherein the catheter tissue interface surface is cooled to a temperature of 10 to 30 degrees C.

48. The method of claim 40, wherein at least 1 cm² of the catheter tissue interface surface is cooled.

49. The method of claim 40, wherein the ablation apparatus includes two or more electrodes, each advanced and retracted from a separate port formed in the catheter tissue interface surface.

50. The method of claim 41, wherein the interior of the tongue is sufficiently ablated to increase a cross-sectional area of an airway passage.