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

• US 9,320,533 B2
• Filed: 07/20/2010
• Issued: 04/26/2016
• 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
• Assistant Examiner(s): Snyder, Melissa A
• Application Number:
  US12/804,398
• Publication Number:
  US 20110021975A1
• Time in Patent Office: 2,107 Days
• Field of Search: 606/184, 606/196, 606/199, 604/103.07
• 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 treating a congested maxillary sinus comprising:

advancing an instrument capable of making a perforation into the ethmoid infundibulum;

positioning the instrument at the anterior and inferior attachment of the uncinate process;

advancing the instrument into a posterior opening of an ethmoid infundibulum superior to a pathway of mucus exit from a posterior ethmoid infundibulum;

assessing a location of the anterior and inferior attachment of the uncinate process;

making a perforation in the uncinate process while minimizing a creation of flail segments, wherein the perforation is neither enlarged nor utilized as a new drainage pathway;

inserting a dilator through the perforation;

positioning the dilator in the ethmoid infundibulum; and

dilating the ethmoid infundibulum by expanding the dilator.

2. The method of claim 1, further comprising:

advancing the dilator into the natural ostium of the maxillary sinus; and

dilating the natural ostium of the maxillary sinus by expanding the dilator.

3. The method of claim 1, wherein the dilator is a guide-free dilator.

4. The method of claim 1, wherein the instrument capable of making a perforation is a backbiting hole punch.

5. The method of claim 1, wherein the skeletal support structure of the uncinate process is maintained after making the perforation.

6. The method of claim 1, wherein the perforation has a diameter of about 3 mm.

7. The method of claim 1 wherein the dilator contains a balloon.

8. The method of claim 7, wherein the balloon has an ellipsoid or figure-8 configuration.

9. A method of treating a congested maxillary sinus comprising:

retracting the middle turbinate;

advancing an instrument capable of making a perforation into the ethmoid infundibulum;

positioning the instrument at the anterior and inferior attachment of the uncinate process;

advancing the instrument into a posterior opening of an ethmoid infundibulum superior to a pathway of mucus exit from a posterior ethmoid infundibulum ;

assessing a location of the anterior and inferior attachment of the uncinate process;

making a perforation in the uncinate process wherein the perforation is neither enlarged nor utilized as a new drainage pathway;

inserting a dilator through the perforation;

positioning the dilator in the ethmoid infundibulum; and

dilating the ethmoid infundibulum by expanding the dilator.

11. The method of claim 9, further comprising:

advancing the dilator into the natural ostium of the maxillary sinus; and

dilating the natural ostium of the maxillary sinus by expanding the dilator.

10. A method of treating a congested maxillary sinus comprising:

advancing an instrument into a posterior opening of an ethmoid infundibulum superior to a pathway of mucus exit from a posterior ethmoid infundibulum;

assessing a location of the anterior and inferior attachment of the uncinate process;

making a perforation in the uncinate process wherein the perforation is used as a conduit through which other structures beyond the perforation can be accessed;

inserting a dilator through the perforation;

dilating the ethmoid infundibulum by expanding the dilator.

12. The method of claim 10, further comprising:

advancing the dilator into the natural ostium of the maxillary sinus; and

dilating the natural ostium of the maxillary sinus by expanding the dilator.

13. A method of treating a congested maxillary sinus comprising:

advancing an instrument into a posterior opening of an ethmoid infundibulum superior to a pathway of mucus exit from a posterior ethmoid infundibulum;

assessing a location of the anterior and inferior attachment of the uncinate process;

retracting the middle turbinate;

advancing an instrument capable of making a perforation into the ethmoid infundibulum ;

positioning the instrument at the anterior and inferior attachment of the uncinate process;

making a perforation in the uncinate process while preserving structural support of the uncinate process, wherein the perforation is neither enlarged nor utilized as a new drainage pathway;

inserting a dilator through the perforation;

positioning the dilator in the ethmoid infundibulum; and

dilating the ethmoid infundibulum by expanding the dilator.

14. The method of claim 13, further comprising:

advancing the dilator into the natural ostium of the maxillary sinus; and

dilating the natural ostium of the maxillary sinus by expanding the dilator.

15. A method of treating a congested maxillary sinus comprising:

advancing an instrument into a posterior opening of an ethmoid infundibulum superior to a pathway of mucus exit from a posterior ethmoid infundibulum;

assessing a location of the anterior and inferior attachment of the uncinate process;

positioning the instrument at the anterior and inferior attachment of the uncinate process;

making a perforation in the uncinate process without removing tissue from the uncinate process, wherein the perforation is neither enlarged nor utilized as a new drainage pathway;

inserting a dilator through the perforation;

positioning the dilator in the ethmoid infundibulum; and

dilating the ethmoid infundibulum by expanding the dilator.

16. The method of claim 15, further comprising:

advancing the dilator into the natural ostium of the maxillary sinus; and

dilating the natural ostium of the maxillary sinus by expanding the dilator.