US2319837A - Adjustable nose splint - Google Patents

Description

May 25, 1943. D. R. WOMACK ADJUSTABLE NOSE SPLINT Filed Dec. 9, 1942 2 Sheets-Sheet l INVENTOR 83:] avid R W1: Th ATI'OR EY ack mil/ y 1943- D. R. WOMACK 2,319,837

ADJUSTABLE NOSE SPLINT Filed Dec. 9, 1942 2 Sheets-Sheet 2 INVENTOR 1:: avi d Hwumafik Patented May 25, 1943 UNITED STATES PATENT OFFICE ADJUSTABLE NOSE SPLINT David R. Womack, United States Navy Application December 9, 1942, Serial No. 468,414

(Granted under the act of March 3, 1883, as

amended April 30, 1928; 3'70 0. G. 757) 6 Claims.

This invention deals with nose splints and more particularly with that type which may readily be adjusted by external resiliently supported holding means, the resilient members being anchored firmly to a band around the patients head.

As in the case of any other bone, the successful treatment of fractures of the nose requires good approximation of the fragments. This is very diflicult to obtain in nasal fractures due to the difilculty in maintaining the parts in position. In the past, fracture devices have been limited to internal and external splints which are not entirely satisfactory. The present device is considered to be an improvement over the other methods now available and to a step in the direction of eventually obtaining a more perfect appliance for maintaining the correct approximation of the fragments of the bones of the nose. There were many changes made in the process of experimentation over a period of two years until the present model was arrived at.

The old internal splints are easily applied but,

due to the secretion of the mucous glands they slide out; and also pressure is unevenly exerted and impossible to evaluate or control. It is also I difiicult or impossible to maintain the proper position of the fragments.

The external appliances were fairly satisfactory with the wire (bent coat hanger) incorporated in a fronto-occipital plaster bandage; however, here again it was diflicult to obtain the proper adjustments and likewise impossible to bend the wire to obtain just the right amount of tension desired. The old external splints using a roller bandage never held at all. Acrilic splints made in the dental laboratory and molded for each individual face did not answer the purpose since they could never be securely fastened and the proper amount of traction or pressure could not be obtained. They usually depended on adhesive plaster fixation which is not at all satisfactory.

An object of the present invention is to produce a device which may be more readily applied and which will not only maintain the bony fragments in proper position but will also aid in first setting them properly.

A further object is to provide an adjustable nose splint which will be comfortable to wear and will least interfere with the normal functions of the other facial organs of the patient, such as the eyes, ears and mouth, or with the normal breathing through the nose.

Other and further objects will become apparent in the following description of a specific form of the present device and its illustrations in the accompanying drawings, wherein:

Fig. l is a perspective view of the device in use;

Fig. 2 is a side elevation thereof, partly in section;

Fig. 3 is a partial front elevation;

Fig. 4 is a plan view partly in section and,

Figs. 5 to 7 are details of parts of the device.

Referring more particularly to the drawings, l and 2 are the vertical and horizontal portions of the supporting member. The vertical portion has many holes 3 suitably drilled therein to reduce the weight. This portion is formed to more or less fit the forehead. When in use, this portion is held by plaster of paris 4 bandaged under and over it to form a rigid band around the edge of a stocking cap fitted over the head of the patient. The horizontal portion is recessed at 26, 26.

A center post 5 is removably fastened under the middle of the horizontal portion 2 as by means of a dowel pin 6 and fillister screw 1, which also holds a middle bearing block 8 on top of the horizontal portion. This post and bearing block may be riveted, brazed or otherwise permanently attached to the horizontal member if desired. A pair of spring clips 9 is riveted to the post 5 as shown at I!) and may be individually drawn toward each other by adjusting nuts II on threaded bolt l2 attached to the end of post 5 and passing through slots l3 in the spring clips. Rubber hose pieces are placed over the ends of these clips as shown in the perspective view (Fig. 1) at M.

Other bearing blocks iii are removably mounted on top of the horizontal piece at each end thereof. A threaded shaft l6 with reduced ends I! fitting in the bearing blocks is rotatably mounted between the middle block 8 and each of the end blocks I5. The outer ends of these shafts are extended and threaded at their tips l8 to receive spherical or other form of nobs 19 for turning the shafts.

The internal pressure bars 20 formed as shown are threadedly mounted on shafts l6 so that they may be adjusted laterally by turning the knobs l9. These bars are bored and tapped at the ends to receive screws 2| and 23, with knobs 22 and 24, at the upper and lower ends of the pressure bars. The upper screws 2| are for adjusting the fore and aft position of the lower end of the bars. The lower screws are for positioning acrylic tips 25 on the ends thereof inward of the nose cavity up to the proper distance.

Thus it may be seen that the position of the acrylic tips may readily be adjusted inwardly 0r outwardly by means of the screws 23, in a fore and aft direction by means of the screws 2| and laterally by means of the knobs l9. The pressure bars 29 being of some springy material, the above adjustments may also be used to increase or decrease the pressure in any direction desired, laterally, forwardly or upwardly.

The present device is designed primarily to ,maintain the bony fragments in their proper position after they have been set. As a matter of fact, it has been found that in nearly all cases the splint can be applied without any previous manipulation and the nose can be set and the fragments adjusted Very simply and quickly by making external adjustments on the device.

A major problem in the fractured nose is the telescoping of the narrow bridge of the nose into the broader basal fragment due to the slanting tion, is what is needed. At the same time a force I must be exerted to straighten out the septum. This elevation oft-he bridge of the nose and the straightening of the septum would be accomplished by some forward pulling device. Basically this idea was carried out in the present fracture device. In addition, there is often some lateral displacement of the nose and something tocorrect this from one side to the other was added in the present instrument.

To maintain traction or pressure inside the nose some fixation area must necessarily be utilized. This is accomplished by the long screws at the end of the adjustable arms of the device. tip of this screw is covered with a small acrilic tip made by the dental department. This small acrilic cap carries the major portion of the stress and strain and must be positioned properly andaccurately to obtain good results. To accomplish this, three adjustments are included-in, the device; first, an in and out adjustment screw on the adjustable arm which would position the cap at the proper place up and down. in the nose; Next, an adjustment is provided by the screw under the flange or horizontal plate to give the adjustment fore and aft necessary to obtain the right amount of lifting power. Lastly, to care for lateral deviations the carriage for the long adjustable arms is a lateral screw placed on the flangeor horizontal plate which will permit wide adjustments of the acrilic cap from one side to the other. By this means the three adjustments are accomplished. The large adjustable arms are symmetrical so that an adjustment point may be maintained in either or both nostrils at the same time. Some fractures require the utilization of only one of the arms while others are best treated by utilizing both arms.

To obtain still more perfect adjustment and to correct for lateral deviations, the two small broadv arms are made of spring steel coming off under the horizontal plate and extending on each side, of the external nose are utilized. Any desired amount of tension can be exerted on these arms by adjusting the small ,screwon the side. This portion of the-device is entirely removable for two reasons: first, some cases do not need any external pressure and the omission of this part simplifies the appearance of the device. Second, it is easier to apply the plaster roller with this part of the device left oif. It is secured by one dowel pin and one screw to the horizontal plate and may be easily applied or removed by means of this screw.

This is a basic instrument. It is applied by first making a stockinette skull cap which is applied over the head without using cotton batting. Two plaster bandages 2% or 3 inches wide are used. A simple occipitofrontal roller is applied being very careful to include the external occipital r protuberance and after two or three turns the instrument is properly positioned with the curved vertical plate resting against the plaster over the forehead in such position as the operator would deem best for the particular fracture in I question. While an assistant holds the fracture device against the head, additional turns of the plaster bandage are placed over and under the horizontal plate until the entire device is secure. Time is then permitted for the plaster to harden and then the acrilio caps are positioned as desired in one or both nostrils. These caps of course should be inserted high enough to come under the nasal bones and exert the proper traction thereon. If there is any large amount of deformity this may be carried out with slow, accurate adjustments, after proper anesthesia of the nose. The positioning is then completed by adjusting the three screws refrred to above, until the proper position is obtained. The lateral external strips are then adjusted to the bridge of the nose externally if desired, or they may not be used at all. These external strips are covered with soft rubber tubing to prevent damage to the nose and too great pressure is not to be exerted since it will cause necrosis. However, adequate pressure for alignment purposes can be maintained without danger of necrosis.

The anesthetic used is the standard A-C mixture which basically is 3% antipyrine' and 1% cocaine applied on cotton tampons inserted in each nostril and left for aperiod of 15 or 20 minutes.

The reduction with the'device is much less painful than the old pulling and application of internal tampons and the wearing of the device is much more comfortable than the old external splints with roller bandages and adhesive tape. Likewise the position is maintained,v which is not the case with the use of external splints as may be found on the market today.

The instrument is quite easily worn and, although it looks awkward, it does not interfere with eating or vision. Patients never complain of wearing it and have uniformly been very grateful with the results obtained.

Various modification in size and form ofparts may be made without departing fro-m the basic features of the present disclosure or the scope of the appended claims.

This invention may be used by or for the Government of the United Statesof America; without the payment to me of anyroyalties thereon or therefor.

What I claim is:

' 1. An adjustablenose splitcomprisihg a band around the patients head a spring strip pivotally connected to said band having. a projection on the end thereof ext nd ng] upwardly into the nasal cavity, meanspadjus'ting this: projection in or out of said cavity, and'means at the upper end of said strip for adjusting the position of the projection in a fore and aft direction as Well as laterally.

2. An adjustable nose splint having a base mounted by suitable means on the patients forehead, a pair of spring strips hil'z'TEd to said base at one end and formed to extend below the nasal opening at the other end, adjustable rods mounted at the latter end for positioning inwardly of the nasal cavity, and adjusting means at the upper end of the strips for individually moving their lower ends fore and aft or laterally as desired.

3. An adjustable nose splint having a base mounted by a suitable means on the patients forehead, a pair of spring strips hinged to said base at one end and formed to extend below the nasal opening at the other end, adjustable rods mounted at the latter end for positioning inwardly of the nasal cavity, adjusting means at the upper end of the strips for individually moving their lower ends fore and aft or laterally as desired and a post suspended from the base plate carrying a pair of spring strips having individual adjusting means for springing them against the sides of the nose to form an external brace.

4. An adjustable nose splint having a base mounted by a suitable means on the patients forehead, a pair of spring strips hinged to said base at one end and formed to extend below the nasal opening at the other end, adjustable rods mounted at the latter end for positioning inwardly of the nasal cavity, adjusting means at the upper end of the strips for individually moving their lower ends fore and aft or laterally as desired, a post suspended from the base plate carrying a pair of spring strips having individual adjusting means for springing them against the sides of the nose to form an external brace, acrylic tips to go over the ends of the adjustable rods inserted in the nose and rubber hose tips over the ends of the strips resting against the sides of the nose.

5. An adjustable nose split comprising a T- formed bar having the top of the T slightly curved to fit the forehead, a bandage for securing this bar to the forehead so that the portion representing the stem of the T extends horizontally in front of the forehead, three bearing blocks on top of this portion, one in the middle thereof and one at each end, a screw-threaded shaft rotatably mounted in bearings between each end block and the middle block, two spring bars having internal threads to fit the screwthreaded shafts freely hinged thereby, one to each shaft, the shafts extending through the end bearing blocks and having knobs on the ends thereof for individual manual adjustment to move the spring bars laterally, a screw passed through a tapped bore in the upper end of each bar and resting against the bottom surface of the horizontal portion of the T-bar for individually adjusting the angular position of the spring bars about the respective screw-threaded shafts, and a long screw passed through a tapped bore in the lower end of each spring bar and extending upwardly in approximately the direction of the nasal passage of the average patient for adjusting acrylic tips mounted on the ends thereof to the proper depth within the nasal passage.

6. An adjustable nose splint comprising a T- formed bar having the top of the T slightly curved to fit the forehead, a bandage for securing this bar to the forehead so that the portion representing the stem of the T extends horizontally in front of the forehead, three bearing blocks on top of this portion, one in the middle thereof and one at each end, a screw-threaded shaft rotatably mounted in bearings between each end block and the middle block, two spring bars having internal threads to fit the screwthreaded shafts freely hinged thereby, one to each shaft, the shafts extending through the end bearing blocks and having knobs on the ends thereof for individual manual adjustment to move the spring bars laterally, a screw passed through a tapped bore in the upper end of each bar and resting against the bottom surface of the horizontal portion of the T-bar for individually adjusting the angular position of the spring bars about the respective screw-threaded shafts, a post removably mounted on the under surface of the horizontal portion of the T-bar, a pair of spring clips attached to the sides of this post and extending to each side of the patients nose, individual screw-threaded studs extending from the bottom of said post through a slot in each spring clip respectively, and nuts threaded to turn freely on these studs for individually biasing each spring clip inwardly toward each other.

DAVID R. WOMACK.

Patent No. 2,319,837 Granted May 25, 1943 DAVID R. WO'MACK The above entitled patent was extended June 26, 1951, under the provisions of the act of June 30, 1950, for 6 years and 169 days, from the expiration of the original term thereof.

Commissioner of Patents.

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