US2377540A - Tonsillotome - Google Patents

Description

June 5, 1945.

A. Das. cosTA TONSILLOTOME 2 Sheets-Sheet l Filed Jan. 24, 1942 lill! to .u .GE

NVENTR. lvaro DB5. EclsTa.

ATTORNEY June 5, 1945. Anas. cosTA TONS ILLOTOME Filed Jan. 24, 1942 2 Sheets-Sheet 2 Alvar D n35 EDE-T ATTORNEY Patented June 5, 1945 TON 'SILLOTOMEn Alvaro da Silva Costa, Rio de Janeiro, Brazil Application January 24, 1942, Serial No. 428,072 In Brazil February 12, 1941 (Cl. 12S-309) 2 Claims.

The present invention relates to present surgical instruments commonly used in the operation for the removal of the tonsils, generally known as a tonsillotome of the guillotine type.

The greatest diliiculty encountered in this operation resides in the over-nux of blood which is generally abundant and very difcult to combat owing to the locality of the region operated upon.

The principal object of the invention is to provide a tonsillotome including a combined rcutting and cautery bar which carries a part of means for galvanic cauterization in the excision of the tonsil, thereby avoiding the over ux of blood which generally occurs from the operation, thru use of the old non-electrical types of tonsillotomes as well as those made to pass high frequency electrical current thru the base of the tonsil either prior. to or during the severing step in the operation.

Another olbject of the invention is to provide a tonsillotome ci the character described embodying characteristics whereby the electric current cannot be delivered to the parts for galvanic cauterization, carried by the combined cutting and cautery bar, until the latter has been moved to a position where it approaches a closed position with respect to the fenestra or guillotine frame.

Another object of the invention is to provide means whereby the equipment for galvanic cauterization may [be conveniently rendered operative by use of the index finger of the surgeon holding and operating the instrument.

Other objects and advantages of the invention will appear in the following description of the preferred embodiment of my invention, taken in connection with the accompanying drawings, forming a part of this specification, and in which drawings:

Fig. l is a side elevation of the tonsillotome with the parts in full lines, in an open position, and by dotted lines showing the relative position f parts which prevent the completion of the electric circuit when the combined cutting and cautery bar is in the position shown.

Fig. 2 is a similar view but showing by dot and dash lines, a hand grasping the instrument and having operated it to advance the combined cutting and cautery bar, and the index linger of the hand in readiness to complete the electric circuit, the dotted lines showing the position of some of the parts for completing the circuit.

Fig. 3 is a View on a larger scale partly in side elevation and partly in central longitudinal section of the instrument, a zone within the oral cavity X being on a greatly enlarged scale to disclose details. f

Fig. 4 is a top plan view of the instrument.

Fig. 5 is an enlarged fragmentary perspective view of a frame member of the instrument, including the fenestra or guillotine frame.

Fig, 6 is a similar view of a part of the hemostat bar.

Fig. 7 is an exploded View of parts for electrical insulation and galvanie cauterization, and to complete the spatulate or head end of the combined cutting and cautery bar.

Fig. 8 is a diagrammatic view showing a typical electric circuit for galvanic cauterization.

Fig. 9 is an enlarged detail view, partly in elevation and partly in vertical section, on the line 9 9 of Fig. 4.

The general construction and arrangement of the main frame and means for operating the combined cutting and cautery bar of the tonsillotome shown in the drawings is old in the art and no claim is made to them, being generally shown to be old in United States'patent to Carstens, 1,397,677, patented November 22, 1921. Briefly such comprises a handle portion I0 and a unit including an elongate frame member I I and a combined cutting and cautery bar I2, which unit is connectable with and disconnectable, as a whole, from the handle portion. The handle portion comprises two handle members I3 and I4, pivotally secured together as at I5 by a suitable pivot pin, as is customary in surgical instruments of this character. Abutting springs I6 secured to the handle members I3 and It, act to yieldingly spread the members apart. The handle members I3 and I4 are formed with grip or grasping portions il and I8, respectively and the handle member I4 is provided with clamp jaw portions !9 operated by a screw 20 to detachably embrace a portion of the frame member I I. The handle member I3 is formed with an actuating arm 2l that is rocked K.back and forth and actuates the bar I2, Spreading movement oi the grip portions may be limited by the actuating arm 2i engaging the clamp screw 20, as shown in Fig. 3. The i'rame member I I is formed with a lengthwise extending slot 22 thru which the actuating arm 2I plays and the bar I2 is formed with a lengthwise slot 23 in which the actuating arm 2l engages to eiiect its reciprocation.

The removable frame member I I has a fenestra or guillotine frame 24 at its forward end, into which the :bar enters, and is formed with overhanging flanges 25 beneath which travels the sides 26 of the bar head 21 of spatulate formation. As is customary the fenestra 23 includes an arcuate or pharyngeal wall 28 presenting a concave surface 29 toward the leading end of the bar, and the leading edge 30 of the head 21 is convex to correspond with the concave surface 29. The shank 3| of the bar is provided with a lengthwise slot 32 and the frame member carries a stud 33 extending thru the slot with a head 34 on the stud engaging the upper face or the shank. rIhis arrangement for guiding the bar is generally old in the art as shown in United States patent to Richter 1,375,177, patented April 19, 1921.

Referring now to the improvements whereby galvanic cauterisation may be accomplished, the head 21 is preferably formed to provide a body portion 35 integral with the shank 3|, a. shoulder 36, and a base tongue 31 having a convex arcuate leading edge 38 extending forwardly from the base portion 35 below the shoulder 36, as shown in Fig. 6. Carried by the base tongue 31 is an arcuate cauterizing knife 39 of electric resistor material, such as platinum, capable of being rendered red hot or sufficiently heated for cauterizing purposes by passing an electric current therethru. This knife has an arcuate cutting edge 4i! bordering the leading edge of tongue 38, and two inwardly directed lugs 4| at its ends remote the cutting edge, providing a central opening 42. It is preferred to electrically insulate the knife 39 from the hemostat head by providing a plurality of relatively thin plates 43, 44 and 45 of insulating material, such as mica, and cap this laminated insualting material with a metal plate 4S, a plurality of rivets 41 being used to secure the parts together and to the tongue 31. The plate 43 rests upon the tongue 31 and is shaped to conform with the upper surface of the tongue. The plate 44 is relatively smaller and substantially fills the opening 42. The plate 45 is similar to plate 43 except that it is provided with cut-away portions 48 so as to expose a part or all of the lugs 4| as shown in Fig. 4. The metal plate 46 is made according to the pattern of plate 45, being provided with cut-away portions 49 for a similar purpose. The tongue is provided with perforations 53 for the Shanks and lower heads ci the rivets 41; the plates 43, 44 and 45, with perforations for the shanks of the rivets 41 and the plate 45 with perforations 52 for the Shanks and upper heads of the rivets. While in the drawings this assembly appears rather thick, because of the enlarged views, it is in practice made relatively thin-less than 115 of an inch by way of example.

Connected to the end portions of the arcuate knife 33 are electrical conductors 53 and 54, which may be relatively stiff wires. These conductors extend along the top of the bar l2 in spaced relation and are provided with terminal portions 55 and 5S respectively at the rear end of t ie bar remote from the head 21. The conductors are electrically insulated from but carried by bar l2 preferably by sleeves 51 of insulating material which surround portions of the Wire, and are received in metal clips 58 secured to the bar as by screws 59.

In order that an electric current may flow thru these conductors and the cauterizing knife when desired an electric current supply unit 60 is provided, adapted to be connected to a source of electric current such as a battery 6| shown in Fig. 8 and flexible conductors 62 and 63 provided with sockets 64 Ifor connection with the unit 60.

The unit 6|) preferably comprises a forked frame 66, the tines 61 and 68 of which straddle the actuating arm 2| and are pivoted to the same by pivot pin 69. The tines 61 and 68 are joined by a trigger 1B located adjacent the grip or grasping portion |1 for operation by use of the index iinger of the surgeon holding the instrument as shown in Fig. 2.

The tines 51 and 58 carry electrical contacts 1| and 12 which are insulated from the tines by sleeves 13 of insulating material. The contacts 1| and 12 may be provided with stems 14 and 15 which may extend into and be secured to the sockets 64.

The tines 61 and 68 are sufficiently short that when the grasping portions |1 and I8 are separated to their fullest extent, and the trigger 10 is pulled, the contacts 1| and r12 will clear the terminal portions 55 and 56 of the conductors 53 and 54, as shown in Fig. l, so that no electric current may then be conducted to the cauterizlng knife. actuated to move the bar I2 to a position where its head is in closing relation to the fenestra, the terminal portions 55 and 56 are brought into the zone of travel of the contacts 1| and 12 as shown by dotted lines in Fig. 2, and the circuit may then be completed by pulling the trigger 10.

It is believed the manner of use of the tonsillotome will be clear from the foregoing description, however it may be noted that after the bar l2 has been moved for the cutting operation o! the throat of the tonsil, the trigger 10 may be operated to complete the electric circuit thru the knife 39 rendering it sufficiently hot for cauterizing purposes.

Iclaim:

1. A tonsillotome, comprising in combination, an elongate frame member provided with a fenestra at one end portion thereof; a bar carried by said frame member, and movable longitudinally in parallel relation thereto, said bar including a head adapted to open and close with respect to said fenestra; handle means including a rst grasping portion rigid with said frame member adjacent its end remote from said fenestra, and a second grasping portion movable with respect to said first grasping portion and operatively engaging said bar to move the latter for closing said fenestra upon movement of said second grasping portion toward said first grasping portion; a cauterizing knife of rigid electric resistor material carried by and electrically insulated from said head; electrical conductors connected to opposite ends of said knife, carried by and electrically insulated from said bar, and having spaced apart terminal portions adjacent said handle means; and an electric current supply unit, adapted to be connected to a. source of electric current, movably carried by said handle means, including a trigger and electrical contaots brought into engagement with said terminal portions by actuation of said trigger only when the gripping portions of said handle means are in said relationship for closing said' fenestra, and said trigger has been pulled, said electrical contacts being eelctrically insulated from each other and from said handle means.

2. In a tonsillotome, the combination of an elongate frame member provided with a fenestra including an arcuate pharyngeal wall; a combined cutting and cautery bar movably carried by said frame member, said bar comprising a shank movable longitudinally of said frame and a head of spatulate formation adapted to Open and close said fenestra upon reciprocation of the However, when the handle portion Il is 4 shank, said head comprising a body portion, at the end of the shank adjacent. the fenestra, a

hase tongue extending from the lower part of the body portion toward the concave face of said pharyngeal wall, said base tongue having a convex arcuate leading edge confronting the concave face of said Wall, and leaving a shoulder above its juncture with said body portion, an

arcuate knife of rigid electric resistor material

Images