JP6327624B2 - Mouthpiece - Google Patents

Description

  The present invention relates to a mouthpiece. More particularly, the present invention relates to a mouthpiece that is attached to the oral cavity in an oral examination or surgery and into which the medical device is inserted in order to introduce a medical device such as an endoscope into the pharynx.

  For example, in the fields of gastroenterology and otolaryngology, oral endoscopy or treatment using an endoscope is performed. This oral endoscopy or treatment includes, for example, upper gastrointestinal endoscopy, endoscopic submucosal dissection, endoscopic pharyngeal surgery, robot-assisted oral pharyngeal surgery, oral throat For example, partial head resection. All of these are widely used for diseases involving the throat and digestive tract. For example, in upper gastrointestinal endoscopy, the endoscope is inserted while the patient holds the mouthpiece. This mouthpiece is intended to protect teeth and an endoscope and to improve the insertability of the endoscope. Such endoscope mouthpieces have conventionally been used in medical fields having substantially the same shape. As an example, a mouthpiece as shown in Patent Document 1 is used. As shown in FIG. 11, the mouthpiece 300 having this conventional structure has flange portions 301 and 302 at both ends and a tooth receiving portion 303 in the middle of the flange portions 301 and 302. The tooth receiving portion 303 has a through hole 304 inside. When the mouthpiece 300 is used, the mouthpiece 300 is held by biting the upper and lower portions of the tooth receiving portion 303 from the upper and lower sides of the subject's incisors (anterior teeth), and the distal end of the endoscope is inserted from the flange portion 302 side. Inspect.

Japanese Utility Model Publication No. 62-61201

  However, in the structure like the mouthpiece 300 that bites the tooth receiving portion 303 with such incisors, it is necessary to keep the tooth receiving portion 303 of the mouthpiece 300 strongly bitten during the inspection, and there is tension from the jaw to the upper jaw. Occasionally, the mouthpiece 300 becomes unstable and may come off during endoscopy. Moreover, since it is necessary to continue biting the tooth receiving part 303 with the incisor, there is a risk that the incisor may be damaged by applying an excessive force.

  In addition, the present inventors have discovered that when the conventional mouthpiece holding the mouthpiece with the incisor similar to the mouthpiece 300 is bitten with the incisor, the back tongue is raised. Then, it was found that the passage leading to the pharyngeal cavity is narrowed by the protuberance of the back tongue, and when the mouthpiece is held by the incisor, the pharyngeal cavity itself is narrowed.

  Therefore, in view of such problems, the present inventors have improved the stability of the mouthpiece, and more easily introduce a medical device such as an endoscope into the pharyngeal cavity. For the purpose of provision.

  The mouthpiece of the present invention is a mouthpiece that is attached to the oral cavity in oral examination or surgery, and into which the medical device is inserted in order to introduce the medical device into the pharynx. A substantially U-shaped portion formed along at least a part of the arrangement of the teeth, and the substantially U-shaped portion is located in the longitudinal center of the substantially U-shaped portion, and the inside An insertion portion configured to be disposed between upper and lower incisors of a human body when a lumen into which a medical device is inserted is formed and the mouthpiece is mounted in the oral cavity, and the insertion portion A pair of extending portions configured to be disposed between upper and lower molars of the human body when the mouthpiece is mounted in the oral cavity, and the pair of extending portions are occluded This makes it possible to hold the mouthpiece in the oral cavity. The features.

  The insertion portion includes an upper incision facing portion that opposes the lower end of the upper incisor and a lower incision facing portion that opposes the upper end of the lower incisor, and the extension portion is located on the upper side during occlusion. It is preferable to have an upper molar contact portion that contacts the lower end of the lower molar and a lower molar contact portion that contacts the upper end of the lower molar.

  Moreover, it is preferable that at least a part of the surface of the extending portion is provided with a soft material that can be deformed at the time of occlusion.

  The extending portion includes a rigid base portion and a soft material provided around the base portion, and the upper molar contact portion and the lower molar contact portion are made of the soft material. It is preferable.

  The extending portion includes a rigid base portion and a thermoplastic resin material provided around the base portion, and the upper molar contact portion and the lower molar contact portion are the thermoplastic resin. It is preferable that it is made of a material.

  Moreover, it is preferable that the pair of extending portions can be elastically deformed in a direction approaching each other.

  In addition, the extension portion and the insertion portion are connected by an interposed member interposed between the extension portion and the insertion portion, and the pair of extension portions are connected to each other. It is preferably elastically deformable in the approaching direction.

  Moreover, it is preferable that a suction path for sucking saliva is formed in the extended portion.

  According to the present invention, the stability of the mouthpiece can be improved and a medical device such as an endoscope can be more easily introduced into the pharyngeal cavity.

It is a perspective view which shows the mouthpiece of one Embodiment of this invention. (A) is a top view of the mouthpiece shown in FIG. 1, (b) is a side view of the mouthpiece shown in FIG. 1, and (c) is a sectional view taken along the line CC of (a). It is a figure which shows the state which bite the mouthpiece of FIG. 1 with the molar. It is a photograph which shows the state of a back tongue and a hyoid bone when the mouthpiece of one Embodiment is bitten by the molar. The functions of the genioglossus muscle, the left and right masseter muscles, the suprahyoid muscle, and the subhyoid muscle when the mouthpiece of one embodiment is occluded by the molar, and the genioglossus muscle when the conventional mouthpiece is occluded by the incisor, It is an electromyogram which shows the action of the masseter muscle, the hyoid bone, the subhyoid muscle. (A) is a figure which shows the state of the intraoral and pharyngeal space when the conventional mouthpiece is bitten by the incisor, and (b) is the mouth and pharynx when the mouthpiece of one embodiment is bitten by the molar. It is a figure which shows the state of a cavity. (A)-(c) is a figure which shows the modification of the mouthpiece of embodiment shown in FIG. (A) is a top view which shows the mouthpiece of other embodiment, (b) is a side view of the mouthpiece of (a), (c) is the DD sectional view taken on the line of (a). is there. It is a figure which shows the state which bite the mouthpiece shown in FIG. 8 with the molar. (A) is a top view which shows the mouthpiece of further another embodiment, (b) is a side view of the mouthpiece of (a). It is a perspective view which shows the conventional mouthpiece. It is a photograph which shows the state of a back tongue and a hyoid bone when the conventional mouthpiece is bitten by the incisor.

  Hereinafter, the mouthpiece of the present invention will be described in detail with reference to the drawings. In the following embodiment, an endoscope mouthpiece will be described as an example. However, the mouthpiece of the present invention is not limited to an endoscope, and other than an endoscope, an oral examination or It can also be used for other medical devices introduced into the pharynx during surgery. Examples of oral examination or surgery include upper gastrointestinal endoscopy, pharyngeal endoscopy, endoscopic submucosal dissection, endoscopic pharyngeal surgery, robot-assisted oral pharyngeal surgery, oral For example, partial pharyngeal laryngectomy may be used, but other examinations or operations may be performed.

  A mouthpiece used in oral examination or surgery is attached to the mouth of a patient lying on an examination table, for example, and the distal end of the endoscope is inserted while attached to the mouth. The distal end of the endoscope inserted into the mouthpiece passes between the tongue and the palate and is introduced into the pharynx (oropharynx, hypopharynx). The distal end of the endoscope introduced into the pharynx is inserted toward the affected part such as the esophagus side, and the affected part is examined or treated.

  Currently, a mouthpiece similar to the mouthpiece 300 having the structure shown in FIG. 11 is used as an endoscope mouthpiece. Such a conventional mouthpiece 300 holds the mouthpiece 300 by biting the tooth receiving portion 303 with upper and lower incisors (anterior teeth), and defines an insertion path of the endoscope. The problems of such a conventional mouthpiece are as follows.

  First, the conventional mouthpiece must continue to bite the tooth receiving portion 303 with the incisors, and the mouthpiece becomes unstable if the patient pulls out the force during examination or surgery. Therefore, the burden on the patient is large. Moreover, since it is necessary to continue to chew the tooth receiving part 303 strongly, the incisor may be damaged depending on the patient.

  Furthermore, the present inventors, in the mouthpiece bite with a conventional incisor, in the insertion of the endoscope, due to the structure of the human body when the mouthpiece is bite with the incisor, in the oral cavity and pharyngeal cavity, I found it difficult to introduce mirrors. FIG. 12 is a radiograph from the side when a conventional mouthpiece (product name: MAJ-674, manufactured by Olympus Co., Ltd.) is held by biting the incisors. Referring to FIG. 12, when the mouthpiece is bitten with the incisor, the entire tongue is rounded, the back tongue T rises in the oral cavity, and the passage between the back tongue T and the palate leading to the pharyngeal cavity is narrowed. . Furthermore, the position of the hyoid bone HB when it is bitten by the incisor is short in the distance between the anterior portion of the hyoid bone HB and the mental M and is positioned below the mental M. In this case, the pharyngeal cavity leading to the esophagus is narrowed.

  The present invention does not hold the mouthpiece depending on the incision by the incisor as in the conventional mouthpiece, but the patient holds the mouthpiece with an easy occlusion by biting with the molar, and It eliminates the bulge of the back tongue and the narrowing of the pharyngeal cavity, making it easier to insert medical devices such as endoscopes than before.

  Hereinafter, the structure of the present invention will be described based on one embodiment, but the present invention is not limited to this embodiment.

  As shown in FIGS. 1 and 2 (a), the mouthpiece 1 of the present invention has a substantially U-shaped portion 2 formed along at least a part of the arrangement of human teeth. The substantially U-shaped portion 2 is a cylindrical or columnar member having a height in the direction in which the upper and lower teeth extend (hereinafter referred to as the vertical direction; the direction indicated by the reference symbol X in FIG. 2B). A portion extending in a substantially U shape in the arrangement direction (the direction indicated by the reference symbol Y in FIG. 2A) (hereinafter also referred to as the longitudinal direction of the substantially U-shaped portion 2). In the present embodiment, the substantially U-shaped portion 2 is formed so as to be able to contact the tooth from the left molar to the molar through the premolar and the incisor. However, the substantially U-shaped part 2 should just be formed along the part of at least the incisor and the premolar tooth among at least average human teeth.

  In this embodiment, as shown in FIG. 1 and FIG. 2A, the substantially U-shaped portion 2 includes an insertion portion 21 and an extension portion 22, and the insertion portion 21 and the extension portion 22 are provided. It is formed in a continuous parabolic shape. The insertion portion 21 is a portion into which a distal end of a medical device (hereinafter simply referred to as an endoscope) such as an endoscope (not shown) is inserted. The insertion part 21 is located in the center part of the longitudinal direction Y of the substantially U-shaped part 2, as FIG.2 (a) shows. The insertion part 21 is a cylindrical part in which a lumen 21a into which an endoscope is inserted is formed, and is arranged between upper and lower incisors of the human body when the mouthpiece 1 is mounted in the oral cavity. The The material of the insertion portion 21 is not particularly limited, but is a slippery material that facilitates insertion of an endoscope, for example, a fluororesin such as polyethylene terephthalate glycol (for example, trade name: Elkojoule (registered trademark)), polytetrafluoroethylene A hard resin such as can be used. In this case, the endoscope can be stably and smoothly guided to the lumen 21a of the insertion portion 21. In addition, the insertion part 21 and the extension part 22 may be formed from a different material, and may be formed with the same material.

  An endoscope is inserted into the lumen 21 a of the insertion portion 21. The size of the lumen 21a can be appropriately changed according to the size of the endoscope to be inserted, and is not particularly limited, but the height in the vertical direction X of the lumen 21a (or the diameter of the lumen 21a). Can be, for example, 5 to 20 mm, preferably 5 to 10 mm or 15 to 20 mm. In the present embodiment, the shape of the lumen 21a is configured such that a cross section cut in a direction perpendicular to the insertion direction Z of the endoscope (see FIG. 2A) is substantially circular. . However, the cross-sectional shape of the lumen 21a is viewed from the upstream side (lower side in FIG. 2 (a)) to the downstream side (upper side in FIG. 2 (a)) of the insertion portion 21. The shape is not particularly limited as long as the mirror can be inserted.

  In the present embodiment, the upstream side of the insertion portion 21 in the insertion direction Z slightly protrudes from the extension portion 22 as shown in FIGS. 1 and 2A, but the extension portion The upstream side of the insertion portion 21 with respect to 22 may be aligned in the insertion direction Z or may be recessed. Moreover, you may provide a flange part in the upstream of the insertion part 21 similarly to the conventional mouthpiece.

  As shown in FIG. 2 (b), the insertion portion 21 has an upper incision facing portion 21b that faces the lower end of the upper incisor and a lower indentation facing portion 21c that faces the upper end of the lower incisor. doing. As shown in FIG. 1, the insertion portion 21 is a cylindrical portion in which a lumen 21 a is formed. The outer periphery on the upper side of the cylindrical insertion portion 21 becomes the upper incisor facing portion 21 b, and the outer periphery on the lower side. Becomes the lower incisor facing portion 21c. The upper incision facing portion 21b and the lower incisor facing portion 21c are portions facing the upper and lower teeth of the insertion portion 21, and will be described in detail below. Basically, the incisors are not in contact with each other, or even when the incisors are in contact, almost no pressure is applied from the upper and lower incisors.

  The shapes of the surfaces of the upper incision facing portion 21b and the lower incision facing portion 21c are not particularly limited, and may be flat or arcuate. The maximum vertical height H1 (see FIG. 2B) between the upper incisor facing portion 21b and the lower incisor facing portion 21c is appropriately changed according to the endoscope used, such as the diameter of the endoscope. Is possible.

  The extension part 22 is extended in the longitudinal direction Y of the substantially U-shaped part 2 toward the both sides from the insertion part 21, as FIG.1 and FIG.2 (a) shows. The extension part 22 is disposed between the upper and lower molars of the human body when the mouthpiece 1 is mounted in the oral cavity, and is sandwiched from above and below by the molars when the mouth is closed. In the present embodiment, the extending portion 22 is provided continuously with the insertion portion 21 and is substantially symmetric with respect to the insertion shaft 21x (see FIG. 2A) of the insertion portion 21 with the insertion portion 21 interposed therebetween. The insertion part 21 and the extension part 22 are configured to have a shape corresponding to the arrangement of the teeth of the human body. In addition, although the insertion part 21 and the extension part 22 are integrally formed continuously in this embodiment, the insertion part 21 and the extension part 22 can be made detachable with respect to each other. As a result, even when the characteristics of the teeth or skeleton of the patient who needs to be examined or treated have changed, or when the size and type of the endoscope such as the diameter of the endoscope to be used change, only the insertion portion 21 is used. Only the extended portion 22 can be replaced, and a mouthpiece can be obtained according to the characteristics of the human body and the endoscope. As long as the insertion part 21 and the extension part 22 can be attached / detached, various attaching / detaching mechanisms such as a screw type and a fitting type can be used.

  The length along the longitudinal direction Y of the substantially U-shaped portion 2 of the extending portion 22 is not particularly limited as long as it can be bitten by a molar (molar or premolar), but in this embodiment, The length from the one end 22a of the extending portion 22 to the other end 22a (the length in the longitudinal direction of the central axis 2x of the substantially U-shaped portion 2 in FIG. 2A) is the left side of the human body. Preferably, the length is the same as or longer than the length from the second molar to the right second molar. In this case, for example, the length of the extending portion 22 can be appropriately changed according to the age of the patient to whom the mouthpiece 1 is attached and the size in the oral cavity, but is, for example, 50 to 150 mm, preferably 80 to It can be 150 mm. Further, when the extension portion 22 is short and is configured to be bitten only by the premolars without being bitten by the molar teeth, the length from one tip 22a of the extension portion 22 to the other tip 22a is short. The length from the left second premolar of the average human body to the right second premolar is preferably the same or longer. In addition, the width from the inner side to the outer side of the extending portion 22 extending in a substantially U shape of the extending portion 22 (the width in the left-right direction in FIG. 2C) is the insertion direction of the inserting portion 21 in this embodiment. It is substantially the same as or slightly shorter than the length of Z, and has substantially the same width from the insertion portion 21 side of the extension portion 22 to the tip 22a of the extension portion 22. The width of the extended portion 22 is a predetermined width (for example, 10 to 20 mm) larger than the width of the tooth. When the extended portion 22 is engaged with the tooth, the outer portion 22d of the extended portion 22 protrudes outside the tooth. It is configured as follows.

  As the material of the extending portion 22, a hard material such as a hard resin, or a soft material such as a soft resin or a rubber material can be used. Further, the surface of the extended portion 22 is subjected to anti-slip processing so that the extended portion 22 is engaged without slipping when the extended portion 22 is bitten by the molar teeth, and the mouthpiece 1 is held in the oral cavity by engagement with light pressure. You may be able to do that. In addition, the extending portion 22 is a soft resin or rubber material that can be deformed at the time of occlusion with a molar tooth in order to stabilize the mouthpiece 1 in the oral cavity by holding the mouthpiece 1 with a light pressure and deforming it. A soft material such as can be used. When the soft material is used as the material of the extending portion 22, the entire extending portion 22 may be formed of the soft material. For example, as in an embodiment shown in FIG. A soft material may be provided on at least a part of the surface.

  As shown in FIG. 2B, the extended portion 22 includes an upper molar contact portion 22b that contacts the lower end of the upper molar at the time of occlusion, and a lower molar contact portion that contacts the upper end of the lower molar. 22c. It should be noted that the upper molar contact portion 22b may be in contact with any of the upper molars at the time of occlusion, and the lower molar contact portion 22c may be in contact with any of the lower molars at the time of occlusion, and need not be in contact with all molars. Absent. In the present embodiment, the upper molar contact portion 22b and the lower molar contact portion 22c are formed flat so as to facilitate engagement with the molar as shown in FIG. 2 (c). The shape of the surface of the contact portion 22b and the lower molar contact portion 22c is not particularly limited, and may be a surface shape that matches the tooth shape. In the present embodiment, the upper molar contact portion 22b and the lower molar contact portion 22c each have a molar region located on the distal end 22a side of the extending portion 22 and a premolar region adjacent to the molar region. Yes. The molar region and the premolar region are regions of the extension portion 22 corresponding to the positions of the molars and premolars of the average dentition of the human body, and those skilled in the art can easily understand the positions. It is.

  The mouthpiece 1 according to the present embodiment is not substantially held only by the incisor as in the conventional mouthpiece, but is held in the oral cavity by the pair of extending portions 22 being bitten by the molar teeth. The That is, by providing the pair of extending portions 22, the mouthpiece 1 is held in the oral cavity by the molar teeth, not by holding the mouthpiece only with the incisors. As shown in FIG. 3, in the mouthpiece 1 of this embodiment, when the patient closes his / her mouth, the extending portion 22 is occluded by upper and lower molars. Compared to a conventional mouthpiece that is substantially held by dots or lines only by the incisors, the mouthpiece 1 of the present embodiment has the extended portion 22 engaged by upper and lower molars and is substantially held by a surface. The Therefore, when the patient holds the mouthpiece 1 during examination or surgery, the mouthpiece 1 can be held with a weaker force than before, greatly reducing the burden on the patient during examination or surgery. Also, as shown in FIGS. 2A and 2B, the pair of extending portions 22 is an outer portion located in a direction away from the insertion shaft 21 x of the inserting portion 21 in the outer periphery of the extending portion 22. When the mouthpiece 1 is attached to the oral cavity, the outer portion 22d is in close contact with the surface of the inner mucous membrane in the oral cavity, and the movement of the mouthpiece 1 in the left-right direction can be restricted. Therefore, by providing a pair of extended portions 22 on the mouthpiece 1, the extended portions 22 are occluded with molar teeth to reduce the burden on the patient, and the stability in the vertical direction in the oral cavity is further improved. Stability in the left-right direction in the oral cavity can be enhanced by the outer portion 22d of the extending portion 22. The pair of extending portions 22 may be elastically deformable in the direction of approaching each other. In this case, when the mouthpiece 1 is put into the oral cavity, the pair of extending portions 22 are attached to the insertion shaft 21x of the insertion portion 21. Since it can be elastically deformed in the direction of approaching each other, it is easy to attach the mouthpiece 1 to the oral cavity even when the mouth of the patient is small, and after the mouthpiece 1 enters the oral cavity, Then, it spreads again and comes into contact with the mucous membrane in the oral cavity to increase the stability of the mouthpiece 1 in the oral cavity.

  When the extended portion 22 is occluded by the molar, the burden on the patient when holding the mouthpiece 1 is reduced, and the stability of the mouthpiece 1 in the vertical and horizontal directions in the oral cavity is improved. In addition to the increase, it was found that the endoscope can be easily inserted when the doctor operates the endoscope. The photograph shown in FIG. 4 is an X-ray photograph from the side when the mouthpiece 1 is bitten by a molar. In FIG. 4, the state of the back tongue when the mouthpiece 1 is bitten by the molar teeth is indicated by the reference symbol T, and the state of the hyoid bone is indicated by the reference symbol HB. FIG. 5 shows the genioglossus muscle when the mouthpiece 1 having the extended portion 22 is bittened and when the conventional mouthpiece (product name: MAJ-674, manufactured by Olympus Corporation) is bitten. It is an electromyogram which shows the action of the masseter, epihyoid, and subhyoid muscles. This electromyogram is placed on the skin of the site corresponding to the genioglossus muscle, the left and right masseter muscles, the upper hyoid bone, and the subhyoid muscle, with the subject in the left lateral position on the examination table, The mouthpiece 1 of the present embodiment and a conventional mouthpiece were attached, and the action potential of each muscle was measured.

  As shown in FIG. 4, when the mouthpiece 1 is bitten by molars, the protrusion of the back tongue T is greatly suppressed compared to the conventional mouthpiece bitten by the incisor shown in FIG. 12. Recognize. The pharyngeal cavity is narrowed by the position of the tongue in the case of the conventional mouthpiece shown in FIG. 12, whereas in the case of the mouthpiece 1 bitten by the molars shown in FIG. Shows that it is getting wider. As is apparent from the electromyogram of FIG. 5, in the case of a mouthpiece engaged with a molar, the amplitudes of the left and right masseter muscles and the suprahyoid muscles are reduced compared to the conventional mouthpiece, and the hyoid bone The amplitude of the lower muscle is increasing. On the other hand, in the conventional mouthpiece, the amplitudes of the masseter and suprahyoid muscles are increased and the amplitude of the subhyoid muscles is decreased. Thus, in the conventional mouthpiece, the masseter muscle works when it is bitten by the incisor. The masseter muscle is a muscle related to mastication, and acts to raise the back of the tongue in order to feed food to the molar side during mastication. Therefore, it can be seen that in the conventional mouthpiece, the masseter acts, the back tongue T rises as shown in FIG. 6A, and the passage leading from the oral cavity to the pharyngeal cavity PC becomes narrow. On the other hand, in the case of a mouthpiece that engages with a molar, the function of the masseter muscle is suppressed as compared with a conventional mouthpiece, and as shown in FIG. Recognize. In the case of a mouthpiece that bites with a molar, as shown in FIG. 5, the amplitude of the suprahyoid muscle increases and the amplitude of the subhyoid muscle decreases, so that the laryngeal cavity L is closed and the pharynx is closed. The cavity PC becomes wider. In this way, in the case of a mouthpiece that bites with a molar, compared to a mouthpiece that bites with an incisor, the back of the back tongue is suppressed and the pharyngeal cavity becomes wider, so the insertion path of the endoscope becomes wider Compared with a conventional mouthpiece, the insertion of the endoscope becomes very easy. Moreover, the risk of misinsertion into the laryngeal cavity side of the endoscope and aspiration due to narrowing of the laryngeal cavity PC is reduced. This frees the patient from pain from contact with the endoscope tip and aspiration during insertion of the endoscope, reduces the burden on the patient, and reduces the burden of the doctor's insertion of the endoscope. And workability is improved.

  In addition, the extension part 22 is not limited to the shape shown by Fig.2 (a)-(c), Other shapes as shown to Fig.7 (a)-(c) may be sufficient. . In the embodiment shown in FIGS. 2A to 2C, the upper molar contact portion 22 b and the lower molar contact portion are arranged such that the height in the vertical direction X gradually decreases toward the distal end 22 a of the extending portion 22. The part 22c (or one of the upper molar contact part 22b and the lower molar contact part 22c) is formed in a taper shape. When configured in this way, the height H2 between the upper molar contact portion 22b and the lower molar contact portion 22c is the height between the upper incisor facing portion 21b and the lower incisor facing portion 21c. It becomes smaller than H1, and the mouthpiece 1 can be easily attached to the oral cavity. Further, as shown in FIG. 3, because of the structure of the temporomandibular joint, when the mouth is opened, the interval on the molar side is narrower than the interval on the incisor side. It can be easily mounted inside, and when the mouthpiece 1 is held in the oral cavity, the mandible has a natural shape, so the burden on the patient's jaw is reduced.

  Also, the height H2 between the upper molar contact portion 22b and the lower molar contact portion 22c is substantially the same as the height H1 between the upper incision facing portion 21b and the lower incised facing portion 21c. As shown in FIG. 7A, the width in the vertical direction X may be substantially the same toward the tip 22 a of the extending portion 22. Also in this case, the mouthpiece 1 can be easily attached to the oral cavity. In addition, as illustrated in FIG. 7B, the extending portion 22 may be formed in a tapered shape so that the height in the vertical direction X increases toward the tip 22 a of the extending portion 22. As shown in FIG. 7 (c), the height in the vertical direction X of the central portion between the connection region between the insertion portion 21 and the extending portion 22 and the tip 22a of the extending portion 22 is large. It may be curved from the center to the connection region so that the height in the vertical direction X decreases from the center to the tip 22a. In the case of FIGS. 7 (b) and (c), the gap between the upper and lower molars becomes wider, so that contact between the incisor and the insertion portion 21 can be prevented more reliably, and occlusion on the molar side is ensured, It is possible to suppress the swelling of the back tongue and enlarge the pharyngeal cavity.

  The height H1 between the upper incisor facing portion 21b and the lower incisor facing portion 21c, the height H2 between the upper molar contact portion 22b and the lower molar contact portion 22c, and the height H1 and high The relationship with the height H2 can be appropriately changed according to the shape and size of the mouth of the patient into which the mouthpiece 1 is inserted, and is not particularly limited. The height H1 between the upper incision facing portion 21b and the lower incision facing portion 21c is appropriately changed according to the diameter of the distal end portion or the insertion portion of the endoscope used, and is not particularly limited. The diameter of the distal end of the endoscope or the insertion portion of the endoscope (the larger of these) is, for example, 1.2 to 2 times, and the dimension is, for example, 6 to 30 mm. Can do. However, in the case of an endoscope having a small diameter such as 5.0 to 6.0 mm, the height H1 is 1 with respect to the diameter of the distal end portion of the endoscope or the insertion portion of the endoscope. .2 to 2 times 6 to 12 mm. In the case of an endoscope having a large diameter such as a diameter of 11 to 14 mm at the distal end portion of the endoscope or the insertion portion of the endoscope, the height H1 is set at the distal end portion of the endoscope or the endoscope. It can be set to 13.2 to 28 mm, which is 1.2 to 2 times the diameter of the insertion portion. The height H2 is also appropriately changed according to the diameter of the distal end portion of the endoscope used, the insertion portion of the endoscope, and the shape and size of the patient's mouth, and is not particularly limited. ), When the height in the vertical direction X gradually decreases toward the tip 22a of the extending portion 22, for example, the height H2 is 0.5 to 0.9 times the height H1. be able to. Further, as shown in FIG. 7B, when the height in the vertical direction X gradually increases toward the tip 22a of the extending portion 22, for example, the height H2 is 1.1 to 1.1 with respect to the height H1. It can be 1.5 times. These ratios and numerical values are merely examples, and the heights H1 and H2 are not limited to the numerical values described above.

  In the present embodiment, as shown in FIGS. 2A and 2C, a suction path P for sucking saliva is formed in the extended portion 22. Unlike the conventional suction path, the structure of the mouthpiece 1 is simplified by providing the suction path P in the extended portion 22 used for occlusion with molar teeth. And since the opening Po1 inside the oral cavity of the suction path P is located at the tip 22a of the extending portion 22, the position of the opening Po1 inside the oral cavity of the suction path P is held at a predetermined position in the oral cavity. Therefore, it is easy to perform a suction operation. Further, since the opening Po1 inside the oral cavity of the suction path P is opened at the tip 22a of the extending portion 22, the saliva can be effectively sucked without sucking the mucous membrane in the mouth during suction. . The suction side opening Po2 of the suction path P is connected to a suction device (not shown). Although the suction side opening Po2 is formed on the upstream end face of the insertion portion 21 in FIG. 1, the suction side opening Po2 may be formed in the extended portion 22.

  Next, another embodiment of the mouthpiece of the present invention will be described with reference to FIG. 8, FIG. 9, FIG. In addition, about the structure similar to embodiment shown by FIGS. 1-7, description is abbreviate | omitted and it demonstrates centering around difference. The matters described in the embodiment shown in FIGS. 1 to 7 can be combined with the matters described in the following embodiments.

  In the mouthpiece 10 shown in FIGS. 8A to 8C, the extending portion 22 includes a base portion 221 having rigidity and a soft material 222 provided around the base portion 221. For the base 221 having rigidity, a material similar to the material of the conventional mouthpiece can be used. For example, a rigid material such as hard resin or metal can be used. The upper molar contact portion 22 b and the lower molar contact portion 22 c are made of a soft material 222. In the present embodiment, the base 221 has a taper-shaped base upper part 221b and a base lower part 221c so that the width in the vertical direction X becomes narrower toward the tip 22a of the extending part 22. However, the base portion 221 may have substantially the same width in the vertical direction X toward the distal end 22a of the extending portion 22 in the same manner as the extending portion 22 shown in FIG. Similarly to the extending portion 22 shown in FIGS. 7B and 7C, the base portion 221 is formed in a tapered shape so that the width in the vertical direction X increases toward the tip 22 a of the extending portion 22. The width in the vertical direction X of the central portion between the connection region between the insertion portion 21 and the extension portion 22 and the tip 22a of the extension portion 22 is large, and the center portion is connected to the connection region. It may be curved so that the width in the vertical direction X decreases from the portion toward the tip 22a.

  As shown in FIGS. 8A to 8C, the soft material 222 covers the periphery of the base portion 221, but the upper molar contact portion 22b and the lower molar contact portion 22c that contact the molar teeth. It is only necessary to be provided at least at the position, and it is not necessary to cover the entire circumference. As the soft material, silicon resin, urethane resin, other soft resin or rubber material is preferably employed. Further, as a modification of the present embodiment, instead of the soft material 222, a thermoplastic resin material that is softened by being attached to warm water or the like (for example, a softening temperature of 50 to 100 ° C.) may be provided around the base portion 22. I do not care. In this case, the attachment of the mouthpiece 10 into the oral cavity of the patient and the deformation of the thermoplastic resin material according to the shape of the molar are facilitated, and the thermoplastic resin material fitted to the molar is then converted into the thermoplastic resin. The material is effective, and the mouthpiece 10 can be stabilized in the oral cavity. In FIG. 8B, the soft material 222 or the thermoplastic resin material is configured so that the heights in the vertical direction X are substantially the same, and the soft material 222 or the thermoplastic material toward the tip 22 a side of the extension portion 22. The resin material is configured to be thick. However, the thickness in the vertical direction X of the soft material 222 or the thermoplastic resin material is not particularly limited, and may be a uniform thickness or a different thickness with respect to the base portion 221. Further, the width in the vertical direction X of the extending portion 22 provided with the soft material 222 or the thermoplastic resin material may be substantially the same width along the longitudinal direction Y of the substantially U-shaped portion 2, You may comprise so that the width | variety of the up-down direction X may become narrow as it goes to the front-end | tip 22a side, and you may comprise so that the width | variety of the up-down direction X may become large.

  The height H3 in the vertical direction X of the base portion 221 of the present embodiment can be changed as appropriate according to the height H1 between the upper incisor facing portion 21b and the lower incisor facing portion 21c, and is particularly limited. It is not a thing. For example, the height H3 is, for example, when the height in the vertical direction X of the base portion 221 gradually decreases toward the tip 22a of the extending portion 22, for example, the height H3 is 0.5 to 0.9 with respect to the height H1. Can be doubled. Further, when the height of the base portion 221 in the vertical direction X gradually increases toward the tip 22a of the extending portion 22, for example, the height H3 may be 1.1 to 1.5 times the height H1. it can. These ratios and numerical values are merely examples, and the heights H1 and H2 are not limited to the numerical values described above.

  In this embodiment, when the mouthpiece 10 is attached to the oral cavity by providing the rigid base 221 and the soft material 222 or the thermoplastic resin material provided around the base 221, FIG. As shown in FIG. 3, the molars bite by deforming the soft material 222 or the thermoplastic resin material of the extended portion 22, but the base 221 becomes a stable point during occlusion with the molar, and slightly above and below the base 221. Stop. And as FIG. 9 shows, the insertion part 21 is not basically occluded by the incisor, and can obtain the same effect as embodiment shown in FIGS. 1-7, the masseter muscle mentioned above, The movement of the suprahyoid and subhyoid muscles can be realized more reliably, and the rise of the back tongue can be suppressed and the pharyngeal cavity can be expanded more reliably.

  In the present embodiment, since the extended portion 22 is provided with the soft material 222 or the thermoplastic resin material around the rigid base portion 221, the soft material 222 or the thermoplastic resin material is occluded at the molar teeth. In addition to functioning as a buffer material, the soft material 222 or the thermoplastic resin material can be deformed following the shape of the teeth. That is, even if the surface irregularities of the teeth and the heights of adjacent teeth are different, the soft material 222 or the thermoplastic resin material is deformed according to the unevenness or height difference, so the mouthpiece Stability when 10 is attached is improved. Moreover, since most or all of the molars basically come into contact with the soft material 222 or the thermoplastic resin material, the pressure at the time of occlusion is dispersed and no burden is applied to the teeth.

  In the embodiment shown in FIGS. 1 to 9, the insertion portion 21 and the extending portion 22 are continuously formed. However, the mouthpiece of the embodiment shown in FIGS. 10 (a) and 10 (b). As for 100, the insertion part 21 and the extension part 22 are connected by the interposed member 23. FIG. The intervention member 23 is only required to be able to connect the insertion portion 21 and the extension portion 22, and may or may not be occluded by teeth. In the embodiment shown in FIGS. 10A and 10B, the interposed member 23 is lower in the vertical direction X than the insertion portion 21 and the extension portion 22 (and / or than the width of the extension portion 22). May also be a tubular or wire-like member. The interposed member 23 may be formed from a rigid material having rigidity, or may be formed from an elastic material having flexibility. When the intervention member 23 is formed of an elastic material, the insertion member 23 is elastically deformed when the mouthpiece 100 is placed in the oral cavity, and the pair of extending portions 22 are connected to the insertion shaft 21x of the insertion portion 21. Since they can be displaced toward each other, the mouthpiece 100 can be easily attached to the oral cavity even when the mouth of the patient is small, and after the mouthpiece 100 enters the oral cavity, It spreads again and touches the mucous membrane in the oral cavity. Further, when the tubular interposing member 23 is used, the inside of the tubular interposing member 23 can be used as the suction path P.

  The extending portion 22 is configured such that, for example, the upper molar contact portion 22b and the lower molar contact portion 22c are in contact with the molar, and the same effect as the embodiment shown in FIGS. 1 to 9 can be obtained. It is possible to realize the movements of the masseter muscle, upper hyoid bone, and subhyoid bone as described above, suppressing the swelling of the back tongue and expanding the pharyngeal cavity.

1, 10, 100 Mouthpiece 2 Substantially U-shaped portion 21 Insertion portion 21a Lumen 21b Upper incisor facing portion 21c Lower incisor facing portion 21x Insertion shaft 22 Extension portion 22a Extension portion tip 22b Upper molar Contact portion 22c Lower molar contact portion 22d Outer portion of extended portion 221 Base portion 221b Base upper portion 221c Base lower portion 222 Soft material 23 Intercalation member 2x Central axis of substantially U-shaped portion L Laryngeal cavity M Gentoid H1 Upper incisor Height in the vertical direction between the opposing portion and the lower incisor facing portion H2 Height between the upper molar contact portion and the lower molar contact portion H3 Vertical height of the base HB Hyoid bone P Suction channel PC Pharyngeal cavity Po1 Opening inside the oral cavity of the suction path Po2 Inhalation side opening of the suction path T Back tongue X Vertical direction Y Teeth arrangement direction (longitudinal direction of the substantially U-shaped part)
Z Endoscope insertion direction

Claims (8)

A mouthpiece that is attached to the oral cavity in an oral examination or surgery and into which the medical device is inserted to introduce the medical device into the pharynx;
The mouthpiece has a substantially U-shaped portion formed along at least a part of an array of human teeth;
The substantially U-shaped part is
Located in the center in the longitudinal direction of the substantially U-shaped portion, a lumen into which the medical device is inserted is formed, and when the mouthpiece is mounted in the oral cavity, the upper and lower incisors of the human body An insert configured to be disposed between;
A pair of extending portions configured to be arranged between the upper and lower molars of the human body when the mouthpiece is mounted in the oral cavity, extending from the insertion portion;
A mouthpiece in which the mouthpiece is held in the oral cavity by engaging the pair of extending portions. The insertion portion has an upper incision facing portion that opposes the lower end of the upper incisor, and a lower incision facing portion that opposes the upper end of the lower incisor,
The mouthpiece according to claim 1, wherein the extending portion has an upper molar contact portion that contacts the lower end of the upper molar at the time of occlusion, and a lower molar contact portion that contacts the upper end of the lower molar. The mouthpiece according to claim 1 or 2, wherein a soft material that can be deformed at the time of occlusion is provided on at least a part of a surface of the extended portion. The extending portion includes a rigid base and a soft material provided around the base, and the upper molar contact portion and the lower molar contact portion are made of the soft material. Item 2. The mouthpiece according to item 2 . The extending portion includes a rigid base portion and a thermoplastic resin material provided around the base portion, and the upper molar contact portion and the lower molar contact portion are made of the thermoplastic resin material. The mouthpiece according to claim 2 configured. The mouthpiece according to any one of claims 1 to 5, wherein the pair of extending portions are elastically deformable in a direction approaching each other. The extension part and the insertion part are connected by an intervention member interposed between the extension part and the insertion part, and the intervention member is in a direction in which the pair of extension parts approach each other. The mouthpiece according to claim 1, which is elastically deformable. The mouthpiece according to any one of claims 1 to 7, wherein a suction path for sucking saliva is formed in the extended portion.