US1630239A - Antrum burr - Google Patents

Description

.R. s. BINKLEY ET Al.

-ANTRU M swan Filed May 9. 1924 Patented May 24,

- BOY SQBI NKLEY, LEONARD -E. 'srnms uirn, Ann THOMAS nenovn, or nAYTomoHIoL i AnrrBUM Bonn,

' i ia i icat on"filed May 9, 1924. Serial m. 711,972."

V Theflpresent invention relatestosurgical instruments and more particularly to an arcuate drill for intranasal aspiration or puncture oftlie' facial sinus or ant-rum.

lhefacial sinus'or antrum of Highniore is a large, cavity of somewhat pyramidal.

form located within the superior maxillary ,l bone. It flS sub ect to numerous surgical diseases, the most common being infection followed. [by Suppuration," necessitating drai1'ia ge.= The ivalls of the antrumare c0mparatively thin, particularly thatportion of the internal Wall which separates: the antruin from thefinfer'ior. meatus of the nasal fos sae." The e itrem'e thinness otfthe internal all and its accessibility through lithe nares renders the intranasal route'desirable for surgical operatioin However,

'means of intran'asal operations'has' been by" I use of a troca'ror cannula, with 'Whichthef '30 a pressure. The tortuous p assagetlirough the;

' due to lack of facilities and suitable instruments for puncturing the internal antrum Wall, surgical preferencehas. been given to operations byvth'e dental'route; which necessitates the sacrificeandeXtrac-i tion of a molar tooth, and drilling through .the alveolar .process, ortoenter/the antrum through the lower exterior Wall, just above the apices ofitlie tooth rootsf The sole antrum Wallis punctured by application of nasal tossze does not readily accommodate a straighttrocai". A curved trocar or cannula is unsuitable since direct drivingpres-u sure is necessary and more or less-twisting or boring movement is required to penetrate the antiu n n all. In such method there isino Way jot controlling the extent of the-bone break j age, and the wall may be, fractured or splintered through a greater'areathan intended. In case the access opening thus t'orm ed 1s lowed by that of a rasp;

In the present invention meansis contemQ plated for enteringjthe antrum through the nasal route by drilling through the Wall be-l tween the aiitruin, and the interior meatus.

Since this point of operation cannot be ap-e preached directly, or v in a straight line throughthe hares, there IS employed an 1n operated by a flexible drive shaft extending tliionghthe hollow curvilinear stem. To

I While the present prevent theydisconnection and the 'burror dril'lingj'implement while in operatioin-ai'ornr-ot split bushing is: provided bushing being-arranged to lock the burr or I drill; head against detachment while permitting i'ts tree rotation. The initial drive shaft v ope'ratedby any suitable motor or source 10f;

powers is interconnected With the flexible sl aft by frictionv drive mechanism, located within thehollow handle of thefinstrument.

drilling instrument, wliichiivill afford: a clean 'llhe'o bject of the invention is to provide a simple but efficient means iorenteringthe maxillary antrum byllneans of a cutting or;

cutoritice, Without fractureor splintering' I of the antrum v all.

" Afurth'er object ofithe inventioii is to provide "a bone drill or thelike, the parts of which are easily and readilyj'faeces'sible for sterilization, 'butfw'hich are so interen gaged and assembled as to, prevent .tlieirfdis connection and loss While in use, andfwhich V \vil 'l- 1noreover be protected against breakage frictional drive means, lyieldable-whencountered,

eve'rabnormal resistance to the drill isen- A fu her obj ectof the invention 15th; fo-

vide an instrument of 'convenien't'jshape land I urvature to accommodate it readily to yarious sizes of nares and by which danger of fracture of the lateral Wall of the nose is obviated, which sometii'nes occurs, incident to the necessary exertion of'pressure onan V V antr-uin trocar.

instrument is especially I des gned and1,adapted for, nasal operations, t is also ap-phoa'ble tor drilling arcuate pas sages as for: instance in splicing bone fractur'es. Byemployi-ng an instrument having too small, the use Oitlie'tr Carmust be fols'tem and burr of proper size, curved p 1 sages be drilled trom, one side of a bone "fracture to the other to permitxthe passage of sutures with the above primary and otherlnot: dental objects" in1 view" as" will -more "fully appear inthe specification, the inventionfl consists o't't'he features of construction, the

t f r f ne'SQE g-l is al I gitudinalsectional viewof the surgical in-v strui'nent forming the subject matter hereof.

V Fig. 2 is an enlarged sectionalview of the detachable inountingfor thelmr r.-; is a modification of the burrmonnting and; drivingconnection Fig. isa; detail view y, ofthewsplit bushing by which the burr is detachably secured to theend of the hollow stein. Flg. 5 is-afdetail VlQXV VO'E'iClIQ trig tion clutchdi sc for the driving connection.

7 Fig.6 illustratesa ,inodifiedzforni' of burr,

. particularly. adapted for drilling curvilinear passages through bone; structure for the 111- V H trocluct on of, splicing sutures and tenons.

Fig. 7 is a Cl'lagrannnatic transverse vertical section of the nasal fossaain a plane anterior w the super or ti rb1iiatecl bone,' showing the f, relation and approxin'iate size of theantrum,

f and having indicated, thereon, the'variousj' routes of'entrance; Fig. Sis a diagrainniat'ic View of a fractured bone splicingop 'eration;

V I Like parts are indicated'by siniilar char- 1 V acters of reference throughout the iseve ral @fviewsfll l r The"Zins'truine n't has been illustrated in the "drawing,'very; nnichenIargedQ It will be -'understood thatthe length and diameter of r the curvilinear-stein and size ofburr will 39 be appropriate tothesiZe of the'parts oper viously other forms of attaching means may curvilinear hollow stem 3 carries the drill orburr 5. V Y

shapes and styles, that shown for illustrative "purposes-being'a spherical burr. The burr 5'is revolublyinounted in asplit bushing 6',

ated upon.

drill; "Detachably secured at'the extremity sist ofa tapered sleeve, carried by the hanupon the handle section 1.' The particular mode of attachment is immaterialand ob- .be substituteda On its outer extremity the Such burrs are made in various screw threaded in the end of the curvilinear shoulder 8, whichp'revents its withdrawal axially from the tbushing 6. ,7 is positioned intermediate the two halves of {lg The bushing i then screwed into the endof the hollow stein as shown in Figs.

7 stem 3. To prevent the accidental disengagem'ent of the burr the shank 7 of the burr is provided'a'tits inner end with ahead or the splitbushingG, as' shown in'detail in i 1, 2 and ,3. Obx iously,zwhen so positioned the burr cannotfbecoine dislodged or accig-f dentallydisconnected andlost in the antrun'i The shank 7 cavity or in the nasal fossaa Secured to the shank7, of the vburr or-drill, preferably perrinanentlyiby' brazing, welding or otherwise,

isa flexible drive shaft 9. This-drive shaft 7 V 9 may be pa small helicallywound wire or spring, as is sometimes leniployed ijor itunay I consist in a chain 'co1npr1sin'g a succession of: 1nterp1voted links. 7 However, 1n practlce .5 r a sect on of wrapped or coveredp ano string has" been "j foun'd' to operate satisfactorily.

small diameter maybe einployedj, At,its

inner end; the flexible shaft 97 is connected to a shank or stud 10, of polygona'l cross gNuinerous forms of flexible shafts are obf e tainable,'.any of whichjifojf sufficiently section, preferably square. v1 This shank J01 stein 10 is loosely. "received" in acor'responding socket in the end of the rdriveshaft '11. 1 Thedrive shaft 11 extends axially within the handle section 1, and is provided with a bear ing in a lug 12', in; one end of'such handle] 7 i mounting and has loose'journal bearings in the nn-er endofthe chuck sleeve Q' at the 013-? "posite-endofthe handle section. 'Fixedly; 1 "secured -to:the d-rive shaft 1 1 is a lfriction drive collar-13, adjacent to which areiloosef 7 1y journale'd upon the drive shaft two' drliv ing gears 1%, spaced apart and jbetweeni whichis interposed aff'riction drive disc 15. "The disc 15 is keyed ,upon the shaft 11 for unison rotation therewith and is free for axial adjustment, Bearin g' upon the 1 gears;

-lton the side opposite the'fixed collar' l3 is a second friction collar'l6, also'keyed upon the-drive shaft'rl l for unison rotation, "but, islidingly adjustable in an axial direction and v exerting pressure upon the gears 14- under ithe influence ofthe springlT. 1 The spring '17 is of helicalrforination, bearingat one end upon the sliding friction collar 16 and 1'05 1 'abuttinglat its opposite ends upon a stop nut l 18, adjustable upon the shaftll', to vary the f friction of the spring and securedin its adjusted position by means of the lock nut 19 *The construct-ion is such that while the gears 14. are looselyjournaled upon the clamped between the friction collars 13 and 16V and the interposed friction disc 15 under springpressure'of suflicient tensionjto afford U the necessary drivingpower. The gears 14' 'lnterinesh wlth' a drivinggear pinion 20 on shaftjll hfor independent rotation, they area counter-shaft 21, suitably journaled in the handle section 1, in' parallel relation with the 1nain drive" shaft 11, and extenclingbeyond; ,the handle section where it 18 connected to a driving'inotor, or other suitable source'of power. The 'fllChlODfll engagement of the,

[collars 13, 15' and 16'with'the driving gears '14 is. s uflicient-to drivethe' shaft 11 and with it the burror drill 5 in any ordinary operati'on. However, should the resistance to the jbur-r or drill become sufficiently mendanger either. the patient or the instrument,

or be such astobeflikely' to cause b reakage Ti' a e sai .J

of the hurn thefrictional driving engage} ment between the collars and the gears wrll he overcome and" inore or less slippagefwi-ll "By" disengag occur.

curvilinear tubular stem '3 maybe *disenv gagedffroni the handle an'd with itlth'e flex;

'ihle' shaft 9, the shank ot whichjloosely v wengages in 'acorrespondingsocket init'he end-of the fsha ft 11;; By unscrewing the bushi n g 6', the burr 5; may be disengaged and the shaft 9' withdrawn iromthe tubular stein; permitting complete sterilizat on of "the operative parts. Inasmuch as the .-head 8 upon tli'eshanli Tofitlie burr prevents'its -accidental"withdrawal and permits its disengagement only by' the unscrewlngof the hushingi'h and" the fact that the burris tricti'o'nally driven, the connection 01 clutch being such as to yield to undue resistance,

theburr is fully protected against breakage, and loss, wl'iilein use.

It may be desirable for some of use, or to meet requirementsof the di-i' fer'ent practitioners to provide for the disengagement of the burr *froin the flexible d rivesliaftll which as hefore mentioned, is

cured tov the burr.

shown in hm n' in Fig 1 and? as permanently se- "@1118 construction is Flg. 3, wherein the flexible shaift 9 is provided with ahead 23, having therein a socket to receive a squared stud 22011 the end of the shank 7 of the burr. The construction is otherwiseas'before described; :This

construction shown in Fig. 3'enables the burr to he replaced without the necessity oireplacing the entire flexible dr ve shaft 9. Inasmuch placement or interchange of burrs.

In Fig. '7 there is shown a burr or drillhead of somewhat different shape, particu la-rlya-pplicahle to the drilling ct-curved passages to facilitate the wiring or-interconnection of fractured bones.v Inasmuch-as such points of operation are more readily accessible, there is less dangerof losing the burr in the opening. It is also desirable thatthe a-rcuate stemfi be of smaller diameter than'the burr, in'order that the hurrinay'v clear itself of bone chips. Theburr illustrated is of mushroom shape or eonoidal formwith the base of the conoidal burr head 1 overhanging the'periphery of the stem. Be

loss of theburr, in such-bone drilling operations, the shank 7" of the burr is preferably journaled directly in the end of the stem. 3. This enablesa ibearmg of larger size and gre a-ter strength. O'tl ierwi-se,- the constructionand operation is a s hefored eseri bed.

mg. the chuck colletlf the 1 conditions shapes into-which the stein jlnight beiibent.

trot-Jar.

drillholes-inathe adjacent ends of the broken even nails or. screws are sometimes used for" this; puigposew' However, such hole'sheretoiore,'have necessarily been straight, andhave usually been; passed diagonallyfromonev side-v tothe other oftheboneandflacro'ss the fracture. The present instrument enables such again ,on the-same sideof the bone uton opposite sides of: the p'ointo'fffractuier operation is somewhat l il-re a stitelr in sewing, v the wire j or suture being the hole thustormed. f'

, v ,there isillhstrated theapplicat on ot the instrument 1 to such: broken one sphcingope'ratwn. Insphcmgiracti is qulte the practice at the presentitime to 0 bone; through which wires-arestrung or *holes to be anus-a throu hcu nvilinear o b w m path,.,entering; the bone; and comnrgrout r plicatiou ot' the'present-instrumentto antral 1 purposesis shown indotted'l'ines. Byitsuse the entrance orifice mayhem-t de" approximately at the bottom of the nasal fossae and I car. Theantral burrdescribed Will'cut its way through'the wall quickly and w'itl r mint somewhatlower than when using a nasal tromum Iain. By lateral motionlthe initial Y opening'may be enlarged ana hema-ans lowa's desired. It the boneis dense orjhaid g there is no (longer of fracture "ask sometimes occurs under the heavy pressure requiredi'to' force a 'trocar through the Wall. 1 Moreover, the use of a: I raspfi o'r enlargement-of the opening is eliminated. In Fig. 7the 'otlierz external routes at present employed are indicated by-the darts 24 and 25 respectively.

Obviously the route 24 necessitates the sac- I rilice'ot a molar tooth. I p

It is obvious" that'theinstrumentherein: shown and described may be applied to many other bone drilling operations as will readily occur-Ito the skilled surgeon. --Forfdifiere11t be made of'var-ious degrees of curvature and of greater or less lengthi' 'lo m'eet unexpurposes, the stem carrying the burr-may,

operation, the tubularlstem may be made. of f,

material capable of being flexed or bentinto various shapes at the time of use to enable" operatlon in otherwise ina'ccesslble locations,

The'fiexibledrive connection enables the operation of the burr through various irregular The instrument 1 is adaptable to dental drill ing "operations and oral surgery,1for which. cause ot-the small diameter of the stemandf since it is unnecessary to protect the instrument aiga'in'stf accidental disengagement or purposes a variety of interchangeabletubuwould be provided; The advantage of the.

instrument torintranasal operations is illustrated in Fig. 7, wherein the'thicken porshown being penetrated at a miuchfilowerl.

lac

,lar stems of different extent and" curvature tionoi; the internalwall of the ant-rum is rvewalllarea .24, as: the point of: ent ce sacrificed drainagefacilities, ibecai' seot its hilitvand-the impossibilityio fiforcing" a a o r 4 i 35. 111 ;a'v surgi cal drill mounting a revoluale necessarily selects the higher an;

the trio car through the thick lower wall.

l From the ahore descriptionlit' will he I apparentth-at {there is thus-provided ay d'ei lce of thecharacter described possessing .theparr vticular features of advantagesz loetoreenumeratedas desirable but which obviously is susceptible ofmodification in its rt rm proportions, detail construction and arrangetment of-paitsavithorit departing vfrom the principle involved orsacriticmg' any of its;

:advantages. a While in "order to complyj with the statute the invention has beenfdesorihed in language more or less specific as tostructural features, it is to; he understoodthat the invent on is notlimited to; the specific deta ls shown but "that the means.andconstruction herein disclosed comprises the preterred'lform of sevf etiect and the "cla med 1n any of its torms-or modifications l lwithin. the legitimate and va Having thus described our invention, we .-1 claim: 1 3O eral; modes of putting the invention into invention s, therefore,

lid scope of the appended claims:

--tion, an inflexible arcuatetuhular sten c'arried thereby a burr revoluhl y mounted at the'extremity ottl-ie arcuate stemi'said arcu ate stein being shaped and proportioned to follow the burr through a restricted passage,

' a flexible shaft extending through the stem and 'operz'itively connected with the revoluble burnfand driv ng means for rotating the shaft located within thechollow handleportionfwith which theffiexible-drive shattis -;operat1-vely connected. 5

12; In a surgical.dri-ll a hollow mounting,

fltrum, a revoluble drill'hurr mounted at the extren'iity of the'cannula and a driving con-' nection extending through the cannula and ".ope'ratively connectingthelhurr with the -I;driving mechanism in the mounting.

a 3. Ina-surgicaldrill meansior' operating, drill burr through iLClllW 'lllllettl" passage including a handle portion, a-curvilinearmounting for the drill burr shapedand.pro-,

; P'OItiOIlG'ClfOI' introduction;through'the nares into: the anti-um," a drill burr rev oluhly mounted atone end thereof, the opposit end ot' saidinounting being; connected to said handle portion and a flexible drive shaft operatively connected with the ".hnrr for ro tating theburr dul -111g its advance through suchcurvilinear path. 7

' 4:. In ajsnrgical drill, a revoluhle burr, aflexible shaft operatively connected with the hollow h andle 'porv- .senibled{relation by. its engagement. Within the hollow stem. E a 8; As an article of manufacture, a unitary fbiirr for: guiding the burrj -lthrough a curilinear path of travel simultaneously :wjith itsfrota tion 'I burr 'an inflexihle tubular stemof seg- ,hurr is revoluhly mounted the' oth'er end of drive stem',-; and: safety ine ans v for preventing the which is connected to said handle portion said stem being shaped and proportioned to ienter any passage "traversed byfsaid hu:r r, a p i shaft extending through tl etubular accidental: detachment of the burr; fromuthe stein while permitting itsfree rotation.

7 *6. Inya drill, a revoluble bnrrfatuhular stem-at one endotwhich'tlieburr is revolu- V bly mounted, a drive shaft extending through the-tubular stem, and a splitibearingforisaidl V burr engaged with the tubular stem, the: burr-1 being shouldered 'on-opposite' sides' of'the split hearing to preventrits withdrawal;

7 -Ina drill of thecharacterdescribecha revolublehurr, a-tuhular stem upon the end."

of which. theburr isimounted ap drive shaft 1 extend ng through the st'e'm, andoperatively connected witlrthe burn t spllt sleevescrfiw threadedzin the extremity of the hollow stem and forming ahea-ring for the burr, and spaced the sleeve while the f latter is heldjin 'asing n'iemloer.

shoulders upon 7 the burr coincident with the opposite endso'f the split; sleeve for preventing the \vithdrawalot the rburriofrom 9. As an article of manufacture, a drill I burr including aw, shank having therein a peripheral groove forming a trunnion, u on which the. burr rotates-and seabed, shoulders definin said peripheral groove.

' 10L Ina drill of the character described,- a tubular stem shapedandproportionedfor ntroduction into a restricted passage,a burr reroluhly mounted the endflof the stem in such position and ot such size asjto' clear a pass ge for the advancement ofjthe" stem;

and hz-ri'ing an integral bearing shank; a" ournalhearrng at the end jof'thestemin; which the shank rotatesrrremovable from the stem with said. burr and "preventing r acci- 7' dental disengagement ofthe; burr from the stem while within the passage, a peripheral shoulder uponthe burr [shank preventing axial withdrawal of the shank from its'bear-g through the tubular stem. I 3

: 11. Inadrill of. the: character described, a

ing, and a drive shaft for thefburrextending hollow handle portio n,- a -l nain, drive shaft 1 drive shaft. 1 p

. I 12. In a drill of the character described,

' f revolubly mountedtherein, africtionaldrive a hollow handle portion, a main drive shaft connection for said-shaft, an arcuateztuhu- 7' lar stem carried by the handle portion, a

drill iburr revolubly mounted atthe extrem- I shaft extending through "the tubular stem and operatively' connecting the; burr and ity of the tubular stem, and a fiexibledrive main drive shaft 13. In a surgical drill of the character de- 7 scribed, a hollow handle portion, arevoluble: maindrive shaft mounted therein, a"chuck at one end of the handle, a hollow bent stein shaped and proportioned foi-jintroduction through the nares into the antrum detachably engageable by'said chuck, a drill burr detachably mounted atthe extremity of the tubular stem, said stem being shaped and proportioned to enterthe passage traversed by said burr, and a supplementaldrive shaft detachably connecting the burr with-the inain drive shaft.- w r 14:. In a surgical drillof the character-de- I scribed, a hollow handle portion, a 'revoluble main "drive shaft mounted therein, a chuck at one endof the handle, an inflexible tubular curvilinear stem of segmental arcuate formation detachably engaged 'by said vchuck, a drill burr revolubly mounted. at the extremity of the stem and guided: thereby through acurvilinear path of travel, said stem beingshape'd and proportioned to enter the passage traversed by .said burr, and a V flexible "drive shaft extending through the curvilinear stem detachably connecting the burr with the main driveshaft;

a revoluble, burr, amounting therefor, a

drive shaft, a pair of spaced collars one of which; is fixedly secured upon the drive shaft, the other of Which'is axially adjusts able thereon but engaged therewith for uni;

sonrotation,and between which the gear is mounted, and a spring urging the movable collar toward the fixe'd'collar to yieldingly ,1

clamp the drive geartherebetweenl- 16. In a'drillfof'thecharacter described, a 'revoluble burr, a mounting therefor, a drive shaft operatively connectedwith-th'e" burr, a countershaft,intermeshing gears operatively connecting the drive shaft ,and'

4 e 15. In a drill of the character described,

drive shaftoperatively connected With the burr, a drive gear loosely journaleduponthe e V countershaftone with the other,' one;of 'said gears; being loosely mounted upon it's shaft, I fandjfriction discs on opposite sides of the Y loosely-mounted gear, mounted for rotat on with" the shaft and yieldingly engaging the shaft 'under spring pressure.

17'. Ina drill of the character described,

a hollow handle section, an arcuatetubular 7 stem detachablyconnectedwith the hollow handle section, 'arevoluble burr detachably mounted at the extremity ofwthe tubular" stem, 21- ma-indrive shaft mounted in the hol .l-owhandle section, afie'xible' shaft detachably connecting the revolublehurr With the main drive shaft, and a frictional drive; clutch transmitting power to the main drive shaft and adapted to yield under undue resistance to the rotation-of the burr.

- In testimony whereof, set ourhands this 5th day ofApril, A. D.

noYs-BiNKLnY;

THOMAS E.: GROVE,

we have hereunto e LEONARD'E. STUTSMAN7

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