US2544588A - Tonsil enucleator - Google Patents

Description

March 6, 1951 s. M. COTTRELL- TONSIL ENUCLEATOR Filed July 7., 1950 INVENTOR.

SAMUEL M. COTTRELL BY ATTORNEY fiateiated Mar. 6, I I a v r an mb n.

I wi r Obieqt; d? an m v 'i t6 d cuttin d n; blaflde.

trated comprises a relatively narrow shank or base portion In terminating in a slightly enlarged and substantially oval-shaped distal portion provided with a similarly oval-shaped aperture l2. The major axis of the aperture I2 is transversely disposed with respect to the longitudinal axis of the shank l and the tonsil to be severed is intended to be received within this aperture. Preferably the upper, surface of the shank is horizontally disposed and the lower surface is gradually tapered, enlarging slightly from front to rear and including a depending handle portion l3 which may, if desired, be formed integrally therewith. As will be more readily apparent from an examination of Fig. l of the drawing, the handle I3 is of the pistol grip type, the forward edge thereof including aplurality of arouate depressions complementarily conformed with respect to the inner surfaces of the fingers of the operator.

' Convenience of grasping in either hand is thus provided, assuring perfect control of the instrument. It has been found advantageous to incline the handle portion 13 at a slight rearward angle from the perpendicular, thereby materially assisting in determining the position at which the instrument will be inserted into the oral cavity of the patient. The length of the shank portion I0 is such that the distal extremity of the instrument will conveniently reach to the Walls of the patients throat with the handle portion spaced adequately from the patients lips to permit visual observation by the surgeon of the operative area. The proximal extremity of the shank Ill, beyond and including the handle portion I3, is provided with an enlarged portion |4 including'vertically disposed side walls I5, a transverse 'end wall l6 and a top wall I! forming a recessed portion within which the proximal extremities of the cutting blade and the upper blade or top shank portion are received, as will be described more fully hereinafter. The cutting blade l8 is relatively thin and narrow, substantially corresponding in width to the width of the shank portion of the instrument, and terminating in an enlarged and oval-shaped distal portion. I 9 provided with an oval-shaped aperture 20 subs'tantially identical in size and shape to the aperture l2. A relatively short slot 2|, communicat ing with the aperture 20, is formed in the cutting blade along the longitudinal axis thereof and the blade is further provided with a cut-away portion 22, spaced slightly from the slot 2|, to assist in the handling and sterilization thereof.

) The opposed extremity of the cutting blade l8 terminates in a stem-like portionor shaft 23 which may be formed integrally therewith'or otherwise rigidly secured thereto and which is externally screw-threaded as indicated at 24 for engagement with'a complementarily internally screw-threaded wing-nut 25 or the like.' To prevent inadvertent disengagement of the wing-nut from the shaft 23, this shaft is formed with a reduced threaded extremity 26 and a lock-nut 21, preferably provided with an appropriately knurled peripheral surface for the more convenient manipulation thereof, is engaged therewith.

As is more particularly illustrated in Fig. of the. drawing, the upper surface of the cutting blade I8 is provided with an upstanding lug 28,

positioned adjacent the rear wall of the cut-away.

portion 22. Vertically disposed grooves or recessed portions 29 and 30 areprovided in the side walls of the lug 28 which provide supporting means for trigger mechanism to be described more fully hereinafter.

Preferably the upper surface of the bottom wall of the recess formed in the enlarged portion l4 of the shank is provided with an arcuate groove 3| intended to receive the threaded shaft 23 and assist in guiding the movement of the cutting blade. To further support the trigger mechanism, laterally disposed ears 32 are provided upon the side edges of the cutting blade. These ears are preferably provided with an arouate rear edge to eliminate aneedlessly sharp or projecting corner and are located in substantial alignment with the lug 28 and immediately to the rear of the opposed grooves 29 and 30.

It. will be understood that the cutting blade |8 rests upon the flat upper surface of the shank or base portion l0 and an upper blade 33 is provided, substantially complementary in configuration to the shank ID, the cutting blade being mounted for reciprocal movement therebetween. The upper blade also terminates in an enlarged and slightly oval-shaped distal portion 34 provided with a similarly oval-shaped aperture 35. Preferably the lower surface of the blade 33 is horizontally disposed and the upper surface is gradually tapered, enlarging slightly from front to rear and provided with a recessed portion 36 extending from the rear or proximal ext'remity thereof intended for the accommodation of the threaded shaft 23. The upper blade is further provided with a longitudinally cut-away portion 31, through which the lug 28 on the cutting blade projects, and with a second longitudinally disposed cut-away portion 38, spaced slightly from the cut-away portion 31, to assist in the handling and sterilization thereof. The proximal extremity of the upper blade 33, to-" gether with the rear extremity of the cutting blade, fit snugly within the recess formed in the enlarged portion M of the shank or base In and suitable means is provided for maintaining the distal extremities of the shank l0 and upper blade 33, with the cutting blade l8 therebetween, inappropriately associated relationship. A preferred embodiment of suchmeans has been illustrated as diametrically opposed, downwardly depending ears 39, located upon themajor axis of the enlarged portion 34 of the upper blade and preferably formed integrally therewith. The free extremities 40 of these cars are turned inwardly and, as is more fully .disclosed in Fig. 6 of the drawing, the enlarged distal extremities II and L9 of the shank l0 and cutting blade l8, respectively, are thus maintained in proper associated relationship. To prevent any possibility of undue freedom of movement of the cutting blade between the upper and lower shank members, a threaded aperture 4| is provided in the upper blade 33 and a similarly threaded aperture 42 positioned in vertical alignment with the aperture 4| is provided in the shank H]. A locking screw 43, having an appropriately knurled head for convenience of manipulation, engages within the aligned apertures 4| and 42 and insures the snug retention of the cutting blade between the opposed horizontal surfaces of the upper blade 33 and shank ID. If desired, a resilient locking plate 44 ma be provided upon the lower surface of the shank I0, positioned for frictional engagement with the knurled head of the screw .43 to prevent inadvertent loosening thereof. It will be observed that the screw 43 projects through the slot 2| in the cutting blade I8 and does not interfere with the necessary freedom of movement of such blade.

, Any desired mechanism may be provided fo imparting appropriate movement to the cutting blade IS. The preferred form thereof comprises a trigger member 45 including a downwardly depending and forwardly curved finger engaging portion 66 provided with a serrated surface 41. For convenience of assembly the trigger is formed in complementary parts and includes a horizontally disposed wall surface 48 located above the finger engaging portion 45. A vertically disposed end wall 49 is provided on the trigger member and the inner surface of this wall includes, a vertically disposed rib 58 intended for engage ment within the groove 29 of the lug 28 on'the cutting blade. The free extremity of the wall surface 48 has an opposed end wall member .51 mounted thereupon, complementary in configuration to the wall 49. As will be more readily apparent from an examination of Fig. 9 of the drawing, the wall member includes a reduced lower extremity 52 receivable within a groove 53 provided in the adjacent side of the trigger member. The inner vertical surface of the wall memprises a pawl 62 pivotally mounted as indicated at 63 upon an ear or the like 64 formed integrally with or otherwise secured to the upper surface of the top wall I! of the enlargedportion M of the shank l0. One extremity of this pawl includes a depending finger 65 which projects through an aperture 86 formed in the top wall I! and engages with the serrations or teeth of a ratchet 61 formed in the upper surface of the threaded shaft 28. The opposite extremity of the pawl, which may be conveniently manufactured from spring steel,.or the like, comprises a resilient portion 68 of reduced thickness which engages against the upper surface of the wall I! at a point remote from the pivotal mounting of the pawl 62. Withthe arrangement of parts thus described, it will be readily understood that as the wing-nut is tightened the finger 85 of the pawl progressively engages with the teeth of the her 51 is complementary to the Wall 49, including ture 5 and the wall 49 is provided with a horizontally disposed transverse aperture 58 positioned in accurate alignment with the threaded aperture 51. A locking screw 59 having a knurled head 60 is provided for maintaining the trigger parts in assembled relationship. This screw 59 is of sufiicient length to project through the aperture 58 in the end wall 49 and an aperture 61 provided in alignment therewith in the lug 28 and engage within the threaded aperture 51 in the detachable wall portion or member 5|.

The operative technique in handling the tonsil enucleator, thus described is particularl simple. With the cutting blade in the position illustrated in Fig. 2 of the drawing, the instrument is grasped in thehand of the surgeon and the distalextremity is positioned below and behind the tonsil to be removed. The operator then gently pushes the tonsil through the aligned apertures in the distal extremities of the upper blade, cutting blade, and shank, using the index finger of the opposite hand. Pressure is then exerted upon the trigger, utilizing the index finger of the hand grasping the instrument for this purpose, and the cutting blade I8 of the device is raised to the position illustrated in Fig. 3 of the drawing Where the tonsil is firmly caught by the forward edge 28' of the aperture 20. It will be observed that the edge 20 is not a sharpened cutting edge or surface, but is a vertically disposed and dull edge having the full thickness of th cutting blade. The wing-nut 25 is then gently threaded to the position illustrated in dotted lines in this figure of the drawing, suitable means being provided to temporarily retain the wing-nut in this adjusted position.

A preferred embodiment of such means comratchet, effectively preventing the return of the cutting blade to normal or inoperative position.

Tightening of the wing-nut 25 is then continued, the procedure being a gentle and gradual one, until the cutting blade is lifted to the position illustrated in Fig. 4 of the drawing, where the forward edge 28' has passed beyond the confines of the apertures l2 and 35, at which time the actual enucleation will have been completed. This technique is especially designed so that the cutting blade moves way from both the anterior and posterior pillars of the tonsil thereby reducing to an absolute minimum the possibility of damaging these structures.

It has been found in practice that the use of a. dull cutting blade, as distinctly opposed to a sharp blade, tends to seal off the small blood vessels as it passes slowly behind the tonsil. This is considered particularly important, where the surgeon takes into consideration the blood clotting time of the patient. If an identical or even substantially similar length of time is taken for the completion of the severance, where the cutting blade is moved from the grasping position, illustrated in Fig. 3 of the drawing, to the final position disclosed in Fig.4, the operation can frequently be completed without loss of blood by the patient. r

The operative technique thus described is as simple as the device itself which includes no delicate or complicated parts which may get out of order or require unduly careful handling. The instrument can be readily and quickly assembled or disassembled and presents no problems in the sterilization thereof. It is particularly light in weight, may be conveniently grasped in either hand and function with a degree of efficiency heretofore unknown in the field of surgery with which we are here concerned.

It will be obvious to those skilled in this profession that various changes may be made in the instrument without departing from the spirit and scope of the invention and, therefore, the invention is not considered limited by that which is illustrated in the drawing and described in the specification, but only as indicated in the appended claims.

What is claimed is:

1. A tonsil enucleator comprising an elongated shank provided with an enlarged distal extremity having an oval-shaped aperture therein, an enlarged portion on the opposite extremity of said shank provided with a longitudinally disposed recess, a pistol grip handle depending from said shank adjacent said opposite extremity, a cutting blade supported upon said shank and movable longitudinally thereof, said cutting blade includareas-as ing: an enlarged distal extremity provided with an" oval-Shaped aperture substantially identical in size to the aperture in said shank, the peripheral wall of the aperture in the cutting blade being perpendicularly disposed with respect to the longitudinal axis of said blade, a screwthreaded shaft on the opposite extremity of said cutting blade receivable within the recess in" said shank'and projecting through the end wall thereof, threaded means engaging the projecting extremity of said shaft and operable to move said cutting blade in a direction toward said handle, an upper blade complementary in configuration to said shank, an enlarged distal extremity on said upper blade having an oval-shaped aperture therein substantially identical insize to the aperture in said shank and coinciding therewith, the opposite extremity of said upper blade being receivable Within the recess ili- Said Shank, diametrically opposed ears formed integrally on" the enlarged portion of said upper blade and depending therefrom, inwardly directed extremities on said ears for engaging beneath said shank and maintaining said shank and upper blade in fixed relationship with the cutting blade movable therebetwcen, a longitudinally disposedslot in said upper blade located adjacent the proximal extremity thereof, an upstanding lug onsaid cutting blade projecting through the slot in said upper blade, trigger means mounted upon said lug and depending beneath said shank for moving said cutting blade in a directiontoward said handle, ratchet teeth formed on the upper surface of said threaded shaft, anda resilient pawl pivotally mounted upon the enlargedportion of said shank and having a depending fin ger projecting through an aperture in said enlarged portion and engaging said ratchet to maintain said cutting blade in adjusted position'.

2'. A tonsil enucleator comprising an elongated shank provided with an enlarged distal extrenrity having an oval-shaped aperture therein, an enlarged portion On the opposite extremity of said shank provided with a longitudinally disposed recess, a' pistol-grip handle depending from said shank adjacent said opposite extrern-- ity, a cutting blade supported upon said shank and movable longitudinally thereof, said cutting blade including an enlarged distal extremity provided with an oval-shaped aperture substantially identical in size to the aperture in said shank, the peripheral wall of the ape'rtureinthe cutting blade being perpendicularly disposed with respect to the longitudinal axis of said blade; 2. screw-threaded shaft on the oppositeextremit'y'of said blade receivable Within the reoess in said shank and projecting through the end wall thereof, threaded means engaging the projecting extremity of said shaft and operable to move said cutting blade in a direction toward said handle, an upper blade complementary in configuration to said shank, an enlarged distal extremity on said upper blade provided with an oval-shaped aperture substantially identical in size to the aperture in said shank and coinciding therewith, the opposite extremity of the upper blade being receivable within the recess in said shank, securing means for maintaining. said upper blade and shank in fixed relationship with the cutting blade movable therebetween, a longitudinally disposed slot in said upper bladelocated adjacent the proximal extremity thereof,

an upstanding lug on said cutting blade projecting through the slot in saidupperblade, trigger means mounted upon said lug'and depending be; heath said shank for moving said cutting blade in a direction toward said handle, and pawl and ratchet means for maintaining said cutting blade in ad usted position when moved thereto by said trigger means.

3. A tonsil enucleator comprising an elongated shank provided with an enlarged distal extrem ity having an oval-shaped aperture therein, the major axis of said aperture being disposed transversely with respect to the longitudinal axis of said shank, an enlarged portion on the opposite extremity of said shank provided with a longitudinally disposed recess including top,- side and end Walls, an angularly inclined pistol grip handle depending from said shank adjacent said opposite extremity, a cutting blade sup" ported upon said shank and movable longitudi-'i nally thereof, said cutting blade being of corn plementary configuration to said shank, an errlarged distal extremity on said cutting blade provided with an oval-shaped aperture substan'-' tially identical in size to the aperture in saidshank, the peripheral wall of the aperture in the cutting blade being perpendicularly disposed with respect to the longitudinal axis of said blade, a screw-threaded shaft on the opposite extremity of said blade receivable within the re-" cess in said shank and projecting through the end wall thereof, threaded means engaging the projecting extremity of said shaft and operable to move the cutting blade in a direction towardsaid handle, an upper blade complementary in configuration to said shank, an enlarged distal= extremity on said upper blade provided with an oval-shaped aperture substantially identical in size'to the aperture in said shank and coincid ing therewith, the opposite extremity of the" upper blade being receivable within the recess in the enlarged portion of said shank, securingmeans for maintaining said upper blade and shank in fixed relationship with the cutting blade movable therebetween, a longitudinally disposed slot in said upper blade located adja-* cent the proximal extremity thereof, an up standing lug in said cutting blade projecting through the slot in the upper blade, trigger means mounted upon said lug and depending beneath said shank for moving said cutting blade in a direction toward said handle, and means for maintaining said cutting blade in ad-- justed position when moved thereto by said trigger means.

4. A tonsil enucleator comprising an elongated shank provided with an enlarged distal extrem ity having an oval-shaped aperture therein; an enlarged portion on the opposite extremity of said shank provided with a longitudinally dis posed recess, a pistol-grip handle depending from said shank adjacent said opposite extrem ity, a cutting blade complementary in configu ration to the shank supported upon said shankand movable longitudinally thereupon, an en-' larged distal extremity on said cutting blade- '2 provided with an oval-shaped aperture substantially identical in: size to the aperture in said shank, the peripheral wall of the aperture in the cutting blade being perpendicularly disposedwith respect to the longitudinal axis of saidblade, a screw-threaded shaft on the opposite extremity of said blade receivable within therecessin said shank and projecting through the end wall thereof, threaded means engagingthe projecting extremity of said shaft and operableto movesaid cutting blade in a direction toward said handle, an upper blade complementary in configuration to said shank, an enlarged distal extremity on said upper blade provided with an oval-shaped aperture substantially identical in size to the aperture in the shank and coinciding therewith, the opposite extremity of the upper blade being receivable within the recess in said shank, securing means for maintaining said upper blade and shank in fixed position with the cutting blade movable therebetween, a longitudinally disposed slot in said upper blade located adjacent the proximal extremity thereof, an upstanding lug on the cutting blade projecting through the slot in said upper blade, and trigger means mounted upon said lug and depending beneath said shank for moving the cutting blade in a direction toward said handle.

5. A tonsil enucleator comprising an elongated shank provided with a longitudinally disposed recess, a pistol-grip'handle depending from said shank adjacent said opposite extremity, a cutting blade complementary in configuration to the shank supported upon said shank and movable longitudinally thereof, an enlarged distal extremity on said cutting blade provided with an oval-shaped aperture substantially identical in size to the aperture in said shank, the peripheral wall of the aperture in the cutting blade being perpendicularly disposed with respect to the longitudinal axis of said blade, a screw-threaded shaft on the opposite extremity of said cutting blade receivable within the recess in said shank and projecting through the end wall thereof, threaded means engaging the projecting extremity of said shaft and operable to move said cutting blade in a direction toward said handle, an upper blade complementary in configuration to said shank, an enlarged distal extremity on said upper blade provided with an oval-shaped aperture substantially identical in size to the aperture in said shank and coinciding therewith, the opposite extremity of said upper blade being receivable within the aperture in said shank, securing means for maintaining said upper blade and shank in fixed relationship with the cutting blade movable therebetween, trigger means for moving said. cutting blade in a direction toward said handle, and pawl and ratchet means for maintaining said cutting blade in adjusted position when moved thereto by said trigger means.

6. A tonsil enucleator comprising an elongated shank provided with an enlarged distal extremity having an aperture therein,,an enlarged portion on the opposite extremity of said shank provided with a longitudinally disposed recess, a pistolshank handle depending from said shank adjacent said opposite extremity, a cutting blade movable longitudinally upon said shank and generally complementary thereto in peripheral configuration, an enlarged distal extremity on said cutting blade provided with an aperture substantially identical in size to the aperture in said shank, the peripheral wall of the aperture in said cutting blade .being perpendicularly disposed with respect to the longitudinal axis of said blade, a screw-threaded shaft on the opposite extremity of said cutting blade receivable within the recess in the shank and projecting through the end wall thereof, threaded means engaging the projecting extremity of said shaft and operable to move said cutting blade in a direction toward said handle, an upper blade generally complementary in peripheral configuration to said shank, an enlarged distal extremity on said upper blade provided with an aperture substantially identical in size to the aperture in said shank and coinciding therewith, the opposite extremity of said upper blade being receivable within the aperture in the shank, means for maintaining said upper blade and shank in fixed relationship with the cutting blade movable therebetween, trigger means for moving the cutting blade in a direction toward said handle, and means for maintaining said cutting blade in adjusted position when moved thereto by said trigger means.

'7. In a tonsil enucleator as set forth in claim 3, spaced side walls on said trigger means, one of said side Walls being separable, vertically disposed ribs on the opposed inner surfaces of said side walls, said ribs being receivable within opposed grooves provided in the side walls of the upstanding lug, and means for maintaining said trigger mounted upon said lug, said side walls being grooved beneath said ribs to embrace said shank, cutting blade, and upper blade.

SAMUEL M. COTTRELL.

No references cited

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