Devices and methods for minimally invasive access to sinuses and treatment of sinusitis

• US 9,247,950 B2
• Filed: 01/04/2011
• Issued: 02/02/2016
• Est. Priority Date: 07/21/2009
• Status: Expired due to Fees

• Current Assignee: Leonard V. Covello
• Original Assignee: Leonard V. Covello
• Inventors: Covello, Leonard V.
• Primary Examiner(s): Price, Nathan R
• Application Number:
  US12/984,281
• Publication Number:
  US 20110105849A1
• Time in Patent Office: 1,855 Days
• Field of Search: 606/184, 606/196, 606/199, 604/104
• US Class Current: 1/1
• 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 a middle turbinate prior to a sinus procedure comprising:

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

expanding the middle turbinate retractor to retract the middle turbinate and reveal a relevant anatomy around an obstructed sinus cavity using an expandable frame having two parallel sides and a rounded portion between the two parallel sides, the expansion also achieved using an intervening pliable frame between the two parallel sides of the expandable frame which enables expansion and compression of the expandable frame, wherein the expandable frame expands to a width of greater than 3 mm and less than 10 mm.

2. The method of claim 1, further comprising:

dilating a hiatus semilunaris superior; and

making a perforation in an anterior wall of an ethmoid bulla.

3. The method of claim 2, further comprising:

advancing a dilator through the perforation until it reaches an ethmoid bulla ostium.

4. The method of claim 3, further comprising:

dilating the ethmoid bulla ostium.

5. The method of claim 4, further comprising:

placing the turbinate retractor between a lateral wall (LW) and the middle turbinate in a coronal plane of the ethmoid bulla ostium with placement being inferior to the ethmoid bulla and then expanding the retractor to retract the middle turbinate to improve an exposure of an uncinate process (UP), an ethmoid bulla (EB), a hiatus semilunaris superior (HSS) and a natural ostium of a maxillary sinus (NOMS).

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

dilating a hiatus semilunaris superior;

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

expanding the middle turbinate retractor to reveal a relevant anatomy around an obstructed sinus cavity;

making a perforation in an anterior wall of an ethmoid bulla;

dilating the perforation;

advancing a dilator through the perforation until it reaches an ethmoid bulla ostium;

dilating the ethmoid bulla ostium; and

placing a posterior/inferior turbinate retractor between a lateral wall (LW) and the middle turbinate in a coronal plane of the ethmoid bulla ostium with placement being inferior to the ethmoid bulla and then expanding the retractor to retract the middle turbinate to improve an exposure of an uncinated process (UP), the ethmoid bulla (EB), the hiatus semilunaris superior (HSS) and a natural ostium of a maxillary sinus (NOMS).

7. The method of claim 6, wherein the dilator includes distal angulation.

8. The method of claim 6, further comprising retracting a middle turbinate prior to dilating the hiatus semilunaris superior.