WO1989001350A1 - A drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning - Google Patents

A drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning Download PDF

Info

Publication number
WO1989001350A1
WO1989001350A1 PCT/SE1987/000364 SE8700364W WO8901350A1 WO 1989001350 A1 WO1989001350 A1 WO 1989001350A1 SE 8700364 W SE8700364 W SE 8700364W WO 8901350 A1 WO8901350 A1 WO 8901350A1
Authority
WO
WIPO (PCT)
Prior art keywords
drainage tube
hole
end portion
dimension
middle portion
Prior art date
Application number
PCT/SE1987/000364
Other languages
French (fr)
Inventor
Olle Berg
Lars Lejdeborn
Original Assignee
Olle Berg
Lars Lejdeborn
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olle Berg, Lars Lejdeborn filed Critical Olle Berg
Priority to US07/465,122 priority Critical patent/US5139502A/en
Priority to EP19870906276 priority patent/EP0375676A1/en
Priority to PCT/SE1987/000364 priority patent/WO1989001350A1/en
Publication of WO1989001350A1 publication Critical patent/WO1989001350A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M27/00—Drainage appliance for wounds or the like, i.e. wound drains, implanted drains
    • A61M27/002—Implant devices for drainage of body fluids from one part of the body to another

Definitions

  • a drainage tube for sinus maxillaris a means for its insertion and a means for making a hole for its positioning.
  • the present invention relates to a drainage tube for crea ⁇ ting permanent access to sinus maxillaris during desired length of time, particularly for drainage of the sinus maxillaris.
  • Sinus maxillaris is often alone or in combina ⁇ tion with other paranasal sinuses seat for infections resulting in suppuration collection with accompanying pain, sourness and weight feeling.
  • the treatment of such infections is firstly directed to drainage of the suppura ⁇ tion collection through punction of the sinus maxillaris and sucking-out of the suppuration and/or flushing. This therapy must, usually in combination with medicine treat ⁇ ment often be repeated several times before the infection has been removed.
  • Puncture and flushing of sinus maxillaris usually take place in such a manner that after local anaesthesia of the nosal mucosa a sharp needle is inserted into the nose below the inferior coucha. .
  • the needle is forced with great force through the bone wall into the sinus maxillaris. Possibly a portion of the suppuration is thereafter sucked out for diagnosis and bacterium culture, whereupon the remaining suppuration amounts on the pressure can be flushed out through the normal but owing to the infection often closed ostium of the sinus maxillaris.
  • the above described treatment is troublesome for the patient parti ⁇ cularly when it often must be repeated several times be ⁇ fore the infection is healed and disappeared.
  • the drainage can be applied in a manner which is al ⁇ most entirely pain-free and liniant for the patient.
  • the diameter of the drainage is such that a continuous discharge of suppuration and secret and inflow of air can take place unprevented.
  • the drainage allows the possibility of sucking out suppuration and secret as well as, wh'en need arises, flushing sinus maxillaris.
  • the configuration and the application is such that the drainage can be maintained during long time and not only cure acute infections but also prevent new infections by providing for continuous out-flow and circulation of air.
  • the drainage allows the insertion of fibre optical equipment.
  • the present invention relates to a drainage tube for the application in a hole made in the bone wall between sinus maxillaris and nasal cavity for treatment of in ⁇ fections in sinus maxillaris and arranged for permanent application on the bone wall during the entire treatment time before its removal by extraction, and the characte ⁇ ristics of the drainage tube according to the invention appear from the enclosed claims.
  • the invention also includes a hole making instrument which, as distinguished from pre ⁇ viously known instruments being pushed through the bone wall, consists of a drill which drills out a bone plug which is catched in the instrument and removed when the hole is finished .
  • This drill is according to the inven ⁇ tion pre-shaped and is in its free end formed as a cir ⁇ cular cutter.
  • the invention provides therefore also a particularly instrument for correct app ⁇ lication of the drainage tube.
  • This instrument is charac- terised in that it is tube-formed having an exterior dimension adapted to the dimension of the hole in the bone wall and an interior dimension adapted to the dimen ⁇ sion of the middle portion of the drainage tube, wherein the free end portion of the instrument is formed to hold the extensible end portion of the drainage tube in an unextended position corresponding to the dimension of the exterior dimension of the middle portion and having a part of this end portion projecting out of the free end of said end portion of the instrument, and wherein the instrument is provided with support means for abutting the surface of the collar-like end portion of the draina ⁇ ge tube being faced away from the extensible end portion.
  • Figs. 1a, b are side views showing a drainage tube according to the invention in two different positions
  • Fig. 2 is a perspective view of a hole making instrument appropriate to use in connection with the drainage tube
  • Fig. 3 shows an instrument for the inser ⁇ tion of the drainage tube
  • Fig. 4 illustrates a drainage tube positioned in situ between sinus maxillaris and nasal cavity.
  • the drainage tube 1 shown in Fig. 1 is in one end provi ⁇ ded with a collar 2 and is out from the opposite end pro ⁇ vided with a slit 3 ending in a hole 4.
  • the drainage tube In level with the hole 4 the drainage tube is formed with opposite recesses 5.
  • the drainage tube consists of an extensible portion 1a below the recesses 5, which portion in relea ⁇ sed position automatically takes the position with out ⁇ wardly projecting legs 6 as shown in Fig. 1b, a middle portion 1b, and an extended portion in the opposite end, i.e. the collar 2.
  • a particular hole making instrument has been developed- This instrument is shown in Fig. 2 and consists of a drill 10 tube-formed at least in the end and provided with a circular cutter 11 having toothed edge,
  • a bone plug is drilled out which is picked-up within the drill tube and is removed together with the drill.
  • the bone plug can be removed from the drill through hole 12.
  • a par ⁇ ticular instrument is developped which in an embodiment is shown in Fig. 3.
  • the instrument consists of a tube 14 having an extended portion 15 for abutment against the collar 2.
  • the tube 14 extends with an end portion 16 through the hole of the collar 2 and past the recesses 5 of the drainage tube for holding the legs 6 abutting each other.
  • the legs 6 project outwardly within sinus maxillaris 9, while the collar 2 is positioned in the nasal cavity 8, whereby the drainage tube 1 becomes fixed.
  • the drainage tube according to the invention is adapted for both permanent and short-time use. It is made in tissue friendly and durable material. If not the material per se is a material with radiographic opacity it can preferably be provided with a radiographic opacity marking.
  • the treatment of a patient and a handling of the invention can take place in the following manner.
  • a hole is made between nasal cavity and sinus maxillaris with the aid of the hole making instrument 10. Due to its form no bone pieces or flakes enter sinus maxillaris 9.
  • the cut-out bone plug is taken out together with the instrument and the hole 13 becomes exactly defined in size.
  • the drainage tube 1 with the legs 6 abutting each other is moved through the hole 13 until the collar 2 abuts the bone wall 7. Thereafter, the inser ⁇ tion instrument is removed and the legs 6 become then auto ⁇ matically folded outwardly.
  • suppuration and secrete can freely flow out into the nasal cavity 8 and air can pass from the nose into sinus maxillaris 9. Suppuration can furthermore be sucked out through the drainage tube.
  • a hose can be inserted through the drainage tube and sinus maxillaris can be flushed, when required.
  • instrument for fibre optical search can be inserted through the drainage tube or the hole.
  • the extendable portion of the drainage tube can for in ⁇ stance be shaped in another way as well as the extended portion.
  • the insertion instrument can be shaped in another way for the adaption to the form of the drai ⁇ nage tube.

Abstract

A drainage tube (1) for drainage of sinus maxillaris consists of a middle portion (1b) having an exterior dimension adapted to a hole made in the bone wall between nasal cavity and sinus maxillaris, an extendible end portion preferably outwardly foldable legs (6) and an opposite end portion (2) widened compared with the middle portion (1b), prefarably a collar. For making the hole in the bone wall is developed a tube-formed drill, which in its free end edge is formed with a toothed cutter, and for the insertion of the drainage tube in position between nasal cavity and sinus maxillaris is developed a particularly insertion instrument.

Description

A drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning.
The present invention relates to a drainage tube for crea¬ ting permanent access to sinus maxillaris during desired length of time, particularly for drainage of the sinus maxillaris. Sinus maxillaris is often alone or in combina¬ tion with other paranasal sinuses seat for infections resulting in suppuration collection with accompanying pain, sourness and weight feeling. The treatment of such infections is firstly directed to drainage of the suppura¬ tion collection through punction of the sinus maxillaris and sucking-out of the suppuration and/or flushing. This therapy must, usually in combination with medicine treat¬ ment often be repeated several times before the infection has been removed.
Puncture and flushing of sinus maxillaris usually take place in such a manner that after local anaesthesia of the nosal mucosa a sharp needle is inserted into the nose below the inferior coucha..The needle is forced with great force through the bone wall into the sinus maxillaris. Possibly a portion of the suppuration is thereafter sucked out for diagnosis and bacterium culture, whereupon the remaining suppuration amounts on the pressure can be flushed out through the normal but owing to the infection often closed ostium of the sinus maxillaris. The above described treatment is troublesome for the patient parti¬ cularly when it often must be repeated several times be¬ fore the infection is healed and disappeared. Moreover, many patients have disposition for recurring infec¬ tions withaccompanying new treatments. At sight these patients stand the risk of developing chronic infections and inflammations which in the end require radical surgi¬ cal evacuation of sinus maxillaris. Summing up this means that now current treatment of acute and chronic purulent infections in sinus maxillaris are unsatisfactory for the following reasons:
1. Puncture and flushing must be often repeated.
2. Give only temporary recovery and must almost always be combined with antibiotic treatment.
3. Do not prevent new infections.
There are also on the market some different types of drainage which, however, all are intended for short use in connection with acute infection. These drainages con¬ sist of a hose having a few millimeters in diameter, which hose with the aid of needle is forced through the bone wall into the sinus maxillaris. The hose applied in such a manner gives the possibility to flush sinus maxillaris during some time without the need for braking up a new hole for each time. By different arrangements the hose is prevented from falling out of sinus maxillaris.
Besides the disadvantage only to be intended for short use in connection with acute infection,these drainages with hoses have other disadvantages deriving from the manner to apply the hose as well as from the shape and the dimension thereof.
These problems have led to the development of the present invention and by the invention the following advantages are obtained:
1. The drainage can be applied in a manner which is al¬ most entirely pain-free and liniant for the patient.
2. The diameter of the drainage is such that a continuous discharge of suppuration and secret and inflow of air can take place unprevented. The drainage allows the possibility of sucking out suppuration and secret as well as, wh'en need arises, flushing sinus maxillaris.
3. The configuration and the application is such that the drainage can be maintained during long time and not only cure acute infections but also prevent new infections by providing for continuous out-flow and circulation of air.
4. The drainage allows the insertion of fibre optical equipment.
In order to obtain the above mentioned advantages, the present invention relates to a drainage tube for the application in a hole made in the bone wall between sinus maxillaris and nasal cavity for treatment of in¬ fections in sinus maxillaris and arranged for permanent application on the bone wall during the entire treatment time before its removal by extraction, and the characte¬ ristics of the drainage tube according to the invention appear from the enclosed claims.
Since it when using a drainage tube according to the invention is essential that the hole in the bone wall between sinus maxillaris and nasal cavity is made with correctly adapted dimension to the drainage tube and that bone wall pieces and flakes are prevented from coming into sinus maxillaris, the invention also includes a hole making instrument which, as distinguished from pre¬ viously known instruments being pushed through the bone wall, consists of a drill which drills out a bone plug which is catched in the instrument and removed when the hole is finished . This drill is according to the inven¬ tion pre-shaped and is in its free end formed as a cir¬ cular cutter.
Also the insertion and the application of the drainage tube are of essential importance. The invention provides therefore also a particularly instrument for correct app¬ lication of the drainage tube. This instrument is charac- terised in that it is tube-formed having an exterior dimension adapted to the dimension of the hole in the bone wall and an interior dimension adapted to the dimen¬ sion of the middle portion of the drainage tube, wherein the free end portion of the instrument is formed to hold the extensible end portion of the drainage tube in an unextended position corresponding to the dimension of the exterior dimension of the middle portion and having a part of this end portion projecting out of the free end of said end portion of the instrument, and wherein the instrument is provided with support means for abutting the surface of the collar-like end portion of the draina¬ ge tube being faced away from the extensible end portion.
Embodiments of the invention are in the following described more in details with reference to the accompanying draw¬ ings, in which Figs. 1a, b are side views showing a drainage tube according to the invention in two different positions, Fig. 2 is a perspective view of a hole making instrument appropriate to use in connection with the drainage tube, Fig. 3 shows an instrument for the inser¬ tion of the drainage tube, and Fig. 4 illustrates a drainage tube positioned in situ between sinus maxillaris and nasal cavity.
The drainage tube 1 shown in Fig. 1 is in one end provi¬ ded with a collar 2 and is out from the opposite end pro¬ vided with a slit 3 ending in a hole 4. In level with the hole 4 the drainage tube is formed with opposite recesses 5. By this form and by using an appropriate material the drainage tube consists of an extensible portion 1a below the recesses 5, which portion in relea¬ sed position automatically takes the position with out¬ wardly projecting legs 6 as shown in Fig. 1b, a middle portion 1b, and an extended portion in the opposite end, i.e. the collar 2. For the application of the drainage tube 1 through the bone wall 7 between nasal cavity 8 and sinus maxillaris 9 (see Fig. 4) a particular hole making instrument has been developed- This instrument is shown in Fig. 2 and consists of a drill 10 tube-formed at least in the end and provided with a circular cutter 11 having toothed edge, When making a hole in the bone wall 7 a bone plug is drilled out which is picked-up within the drill tube and is removed together with the drill. Hereby is secured that bone pieces or flakes do not fall into sinus maxillaris 9. After removing the drill the bone plug can be removed from the drill through hole 12.
For the positioning of the drainage tube 1 in a hole 13 in the bone wall 7 (Fig. 4) made by the drill 10 a par¬ ticular instrument is developped which in an embodiment is shown in Fig. 3. The instrument consists of a tube 14 having an extended portion 15 for abutment against the collar 2. The tube 14 extends with an end portion 16 through the hole of the collar 2 and past the recesses 5 of the drainage tube for holding the legs 6 abutting each other. When the instrument is removed, the legs 6 project outwardly within sinus maxillaris 9, while the collar 2 is positioned in the nasal cavity 8, whereby the drainage tube 1 becomes fixed.
The drainage tube according to the invention is adapted for both permanent and short-time use. It is made in tissue friendly and durable material. If not the material per se is a material with radiographic opacity it can preferably be provided with a radiographic opacity marking.
The treatment of a patient and a handling of the invention can take place in the following manner. After appropriate anaesthesia of the nasal mucosa a hole is made between nasal cavity and sinus maxillaris with the aid of the hole making instrument 10. Due to its form no bone pieces or flakes enter sinus maxillaris 9. The cut-out bone plug is taken out together with the instrument and the hole 13 becomes exactly defined in size. With the aid of the insertion instrument 14 the drainage tube 1 with the legs 6 abutting each other is moved through the hole 13 until the collar 2 abuts the bone wall 7. Thereafter, the inser¬ tion instrument is removed and the legs 6 become then auto¬ matically folded outwardly. Through the hole in the drai¬ nage tube 1 suppuration and secrete can freely flow out into the nasal cavity 8 and air can pass from the nose into sinus maxillaris 9. Suppuration can furthermore be sucked out through the drainage tube. A hose can be inserted through the drainage tube and sinus maxillaris can be flushed, when required. Moreover, instrument for fibre optical searchcan be inserted through the drainage tube or the hole. When removing the drainage tube after desired time, the collar 2 can for instance be grasped by tongs and the drainage tube be drawn straight outward¬ ly. Due to the flexible soft structure of the drainage tube the legs 6 are drawn together when passing through the hole 13 in the bone wall 7.
The invention is not limited to the embodiments described above and shown on the drawings but can be varied in seve¬ ral ways within the frame of the following claims. Thus, the extendable portion of the drainage tube can for in¬ stance be shaped in another way as well as the extended portion. Moreover, the insertion instrument can be shaped in another way for the adaption to the form of the drai¬ nage tube.

Claims

CLAIMS:
1. A drainage tube (1) to be positioned in a hole (13) made in the wall (7) between nasal cavity (8) and sinus maxillaris (9) for treatment of infections in sinus maxillaris and arranged for permanent positioning in the wall during the entire treatment time before its removal by extraction, c h a r a c t e r i z e d in that the drainage tube (1) consists of a middle portion (1b) having an exterior dimension closely adapted to the dimension of the hole (13) and having an interior dimension sufficiently large for guaranteeing continuous flow of suppuration and secret as well as gas exchange through the drainage tube, an end portion (1a) automati¬ cally extendible to a larger dimension than the middle portion (1b) to be arranged in sinus maxillaris (9) , and an opposite collar-like end portion (2) having larger dimension than the middle portion (1b) to be arranged in the nasal cavity (8) , the length of said middle portion (1b) substantially corresponding to the thickness of said wall (7) for substantially fixed arrangement of the drainage tube (1) at the wall besides due to the closed adaptment of the middle portion also due to the abutment of said end portions (1a,2) against the surfaces around said hole (13) on both sides of the wall.
2. A drainage tube according to claim ^ c h a r a c t e ¬ r i z e d in that said extendible end portion (1a)" con¬ sists of at least one outwardly foldable leg (6) .
3. A drainage tube according to claim 1 or 2, c h a r a c t e r i z e d in that said extendible end portion (1a) is formed by a slit (3) extending from the end of the drainage tube and substantially up to said middle portion (1b) .
4. A drainage tube according to claim 1, c h a r a c ¬ t e r i z e d in that the drainage tube is made of a soft tissue-friendly material, preferably plastic material.
5. A drainage tube according to claim 4, c h a r a c t e ¬ r i z e d in that the drainage tube is made of material with radiographic opacity.
6. Means for insertion a drainage tube (1 ) according to claim 1 in a hole (13) made in the bone wall between na¬ sal cavity (8) and sinus maxillaris (9) , c h a r a c t e ¬ r i z e d in that said insertion means (14-16) is tube- formed having an exterior dimension adapted to the dimen¬ sion for the hole (13) in the bone wall (7) and an inte¬ rior dimension adapted to the middle portion (1b) of the drainage tube (1), the free end portion (16) of said in¬ sertion means being formed to hold the extendible end portion (1a) of the drainage tube in a non-extended posi¬ tion corresponding in dimension to the outer dimension of said middle portion (1b) and with a part of said extend¬ ible end portion (1a) projecting out of the free end of said end portion (16) of said insertion means, and said insertion means being provided with support means (15) for abutment against the surface of said collar-like end portion (2) of the drainage tube faced away from said extendible end portion (1a) .
7. Means for making hole (13) in the bone wall (7) : between nasal cavity (8) and sinus maxillaris (9) for positioning a drainage tube (1) according to claim (1) , c h a r a c t e r i z e d in that said hole making means (10) consists of a tube-formed drill, the free end edge of which being formed as a circular cutter (11) .
PCT/SE1987/000364 1987-08-19 1987-08-19 A drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning WO1989001350A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US07/465,122 US5139502A (en) 1987-08-19 1987-08-19 Drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning
EP19870906276 EP0375676A1 (en) 1987-08-19 1987-08-19 A drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning
PCT/SE1987/000364 WO1989001350A1 (en) 1987-08-19 1987-08-19 A drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/SE1987/000364 WO1989001350A1 (en) 1987-08-19 1987-08-19 A drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning

Publications (1)

Publication Number Publication Date
WO1989001350A1 true WO1989001350A1 (en) 1989-02-23

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/SE1987/000364 WO1989001350A1 (en) 1987-08-19 1987-08-19 A drainage tube for sinus maxillaris, a means for its insertion and a means for making a hole for its positioning

Country Status (3)

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US (1) US5139502A (en)
EP (1) EP0375676A1 (en)
WO (1) WO1989001350A1 (en)

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US5139502A (en) 1992-08-18

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