Methods and apparatus for treating disorders of the ear, nose and throat

• US 8,961,398 B2
• Filed: 10/31/2007
• Issued: 02/24/2015
• Est. Priority Date: 04/21/2004
• Status: Active Grant

• Current Assignee: Acclarent Incorporated (Johnson & Johnson)
• Original Assignee: Acclarent Incorporated (Johnson & Johnson)
• Inventors: Makower, Joshua, Chang, John Y., Muni, Ketan P., Morriss, John H., Ha, Hung V., Kim, Isaac J., Vrany, Julia D.
• Primary Examiner(s): Kasztejna, Matthew J
• Assistant Examiner(s): BARRY III, KEVIN GRANT
• Application Number:
  US11/930,786
• Publication Number:
  US 20080119693A1
• Time in Patent Office: 2,673 Days
• Field of Search: 600/103, 600/104, 600113-116, 600121-123, 604/99.01, 606/199
• US Class Current: 600/114
• CPC Class Codes: A61B 1/00135 Oversleeves mounted on the endoscope prior to insertion
• CPC Class Codes: A61B 1/0051 with controlled bending of insertion part
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/233 for the nose, i.e. nasoscopes , e.g. testing of patency of Eustachian tubes
• CPC Class Codes: A61B 1/267 for the respiratory tract, e.g. laryngoscopes, bronchoscopes
• 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 17/2804 with two or more pivotal connections A61B17/29 takes precedence
• CPC Class Codes: A61B 17/282 Jaws
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2017/3447 Linked multiple cannulas
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2065 Tracking using image or pattern recognition
• CPC Class Codes: A61B 2090/063 for measuring volume
• CPC Class Codes: A61B 2090/0811 for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/3941 Photoluminescent markers
• CPC Class Codes: A61B 2090/3954 magnetic, e.g. NMR or MRI
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61M 2029/025 : characterised by the guiding element
• CPC Class Codes: A61M 2210/0681 : Sinus (maxillaris)
• CPC Class Codes: A61M 29/02 : Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

Methods and apparatus for treating disorders of the ear, nose, throat or paranasal sinuses, including methods and apparatus for dilating ostia, passageways and other anatomical structures, endoscopic methods and apparatus for endoscopic visualization of structures within the ear, nose, throat or paranasal sinuses, navigation devices for use in conjunction with image guidance or navigation system and hand held devices having pistol type grips and other handpieces.

Claims

1. A method for enlarging an ostium of a paranasal sinus, the method comprising:

(a) inserting an endoscopic guide system into a nasal cavity or paranasal sinus, wherein the endoscopic guide system comprises;

(i) a tubular guide having a proximal end, a distal end and, a lumen that extends longitudinally therethrough, wherein the distal end of the tubular guide comprises a curved distal tip having a distal opening, wherein the distal tip is flexible,

(ii) an endoscope incorporated in or attached to the tubular guide;

(b) advancing the distal end of the tubular guide within the nasal cavity or paranasal sinus toward the ostium while viewing the tubular guide using the endoscope by maintaining an outer surface of the tubular guide within a field of view of the endoscope;

(c) rotating the tubular guide relative to the endoscope and within the nasal cavity or paranasal sinus, about a longitudinal axis defined by the tubular guide, to thereby orient the distal opening of the distal tip toward the ostium;

(d) advancing a balloon dilatation catheter though the lumen of the tubular guide and over a guidewire to position a balloon of the catheter in the ostium; and

(e) inflating the balloon to enlarge the ostium.

2. A method according to claim 1, further comprising viewing the balloon using the endoscope.

3. A method according to claim 1, wherein inserting the endoscopic guide system comprises:

inserting the tubular guide, wherein the guide comprises two side-by-side tubes, each tube forming a lumen; and

advancing the endoscope through one of the tube lumens.

4. A method according to claim 1, wherein inserting the endoscopic guide system comprises:

inserting the tubular guide, wherein the guide comprises an attachment member coupled with an outer surface of the guide; and

coupling the endoscope to the guide via the attachment member.

5. A method according to claim 1, wherein the endoscopic guide system is inserted transnasally.

6. A method for enlarging an ostium of a paranasal sinus, the method comprising:

(a) inserting an instrument into a nasal cavity to position the instrument adjacent to a turbinate in the nasal cavity;

(b) manipulating the instrument within the nasal cavity to engage opposite sides of the turbinate to thereby remodel the turbinate by crushing the turbinate between opposing surfaces of the instrument;

(c) inserting an endoscopic guide system into a nasal cavity or paranasal sinus, wherein the endoscopic guide system comprises;

(i) a tubular guide having a proximal end, a distal end, and a lumen that extends longitudinally therethrough,

(ii) an endoscope attached to the tubular guide, and

(iii) a guidewire, wherein a distal end of the guidewire comprises a surgical tool;

(d) advancing the distal end of the tubular guide toward the ostium while viewing the tubular guide using the endoscope;

(e) advancing the distal end of the guidewire into the paranasal sinus and actuating the surgical tool therein;

(f) advancing a balloon dilatation catheter though the lumen of the tubular guide and over the guidewire to position a balloon of the catheter in the ostium; and

(g) inflating the balloon to enlarge the ostium.

7. A method for enlarging an ostium of a paranasal sinus, the method comprising:

(a) inserting an endoscopic guide system into a nasal cavity or paranasal sinus, wherein the endoscopic guide system comprises;

(i) a tubular guide having a proximal end, a distal end, and a lumen that extends longitudinally therethrough, wherein the distal end of the tubular guide is curved such that the proximal end and the distal end are oriented along different respective axes,

(ii) an endoscope advanceable alongside the tubular guide wherein the endoscope has a substantially straight profile, and

(iii) a coupling mechanism, wherein the coupling mechanism is operable to couple the tubular guide to the endoscope in a plurality of rotational positions;

(b) advancing the distal end of the tubular guide toward the ostium while viewing the curved distal end of the tubular guide using the endoscope;

(c) rotating the tubular guide within the nasal cavity or paranasal sinus and securing the tubular guide within the coupling mechanism while within the nasal cavity or paranasal sinus;

(d) advancing a balloon dilatation catheter though the lumen of the tubular guide to position a balloon of the catheter in the ostium; and

(e) inflating the balloon to enlarge the ostium.