Abstract:
A method and apparatus are disclosed for treating a condition of a patient&#39;s airway. The condition is attributed at least in part to a spacing of tissue from opposing surfaces in the airway. In one embodiment, the method and apparatus include placing a tissue contractor within the tissue. The contractor includes a static end and a tissue in-growth engaging end. The static end is secured to a bony structure adjacent to tissue to be contracted. The tissue in-growth engaging end is secured to the tissue and spaced from the bony structure. A spacing between the tissue engaging end and a bony end is contracted in order to place the tissue under tension.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     This invention pertains to a method and apparatus for treating a condition of an upper airway of a patient. More particularly, this invention is directed to such a method and apparatus including an implant to improve patency of the airway.  
         [0003]     2. Description of the Prior Art  
         [0004]     Upper airway conditions such as obstructive sleep apnea (“OSA”) and snoring have received a great deal of attention. These conditions have recognized sociological and health implications for both the patient and the patient&#39;s bed partner.  
         [0005]     Numerous attempts have been made towards treating OSA and snoring. These include placing implants in either the tissue of the soft palate or the pharyngeal airway as disclosed in commonly assigned U.S. Pat. No. 6,250,307 to Conrad et al. dated Jun. 26, 2003, U.S. Pat. No. 6,523,542 to Metzger et al. dated Feb. 25, 2003 and U.S. Pat. No. 6,431,174 to Knudson et al. dated Aug. 13, 2002. Further, U.S. Pat. No. 6,601,584 to Knudson et al. dated Aug. 5, 2003 teaches a contracting implant for placement in the soft palate of the patient.  
         [0006]     In the &#39;584 patent, an embodiment of the contracting implant includes two tissue attachment ends (for example ends 102b in FIGS. 46 and 47) which are maintained in a space-apart, stretched relation by a bio-resorbable member 102c which surrounds an internal spring or resilient member 102a. After implantation, tissue grows into the attachment ends 102b. The bioresorbable member 102c is selected to resorb after the tissue in-growth permitting the resilient member 102a to contract drawing ends 102b together as illustrated in FIG. 47 of the &#39;584 patent (incorporated herein by reference). Tissue contraction is believed to be desirable in that the tissue contraction results in a debulking of the tissue and movement of tissue away from opposing tissue surfaces in the pharyngeal upper airway.  
         [0007]     Another prior art technique for treating OSA or snoring is disclosed in U.S. Pat. No. 5,988,171 to Sohn et al. dated Nov. 23, 1999. In the &#39;171 patent, a cord (e.g., a suture material) (element 32 in FIG. 6 of the &#39;171 patent) is placed surrounding a base of the tongue and secured to the jaw by reason at an attachment member (element 20 in FIG. 6 of the &#39;171 patent). In the method of the &#39;171 patent, the member 32 can be shortened to draw the base of the tongue toward the jaw and thereby move the tissue of the base of the tongue away from the opposing tissue of the pharyngeal airway. However, this procedure is often uncomfortable. This procedure, referred to as tongue suspension, is also described in Miller et al., “Role of the tongue base suspension suture with The Repose System bone screw in the multilevel surgical management of obstructive sleep apnea”,  Otolaryngol. Head Neck Surg.,  Vol. 126, pp. 392-398 (2002).  
         [0008]     Another technique for debulking tissue includes applying radio frequency ablation to either the tongue base or of the soft palate to debulk the tissue of the tongue or palate, respectively. This technique is illustrated in U.S. Pat. No. 5,843,021 to Edwards et al. dated Dec. 1, 1998. RF tongue base reduction procedures are described in Powell et al., “Radiofrequency tongue base reduction in sleep-disordered breathing: A pilot study”,  Otolaryngol. Head Neck Surg.,  Vol. 120, pp. 656-664 (1999) and Powell et al., “Radiofrequency Volumetric Reduction of the Tongue—A Porcine Pilot Study for the Treatment of Obstructive Sleep Apnea Syndrome”,  Chest,  Vol. 111, pp. 1348-1355 (1997).  
         [0009]     A surgical hyoid expansion to treat OSA is disclosed in U.S. Pat. No. 6,161,541 to Woodson dated Dec. 19, 2000. Other tongue treatments for OSA include stimulation of the hypoglossal nerve. This procedure is described in Eisle et al., “Direct Hypoglossal Nerve Stimulation in Obstructive Sleep Apnea”,  Arch. Otolaryngol. Head Neck Surg.,  Vol. 123, pp. 57-61 (1997).  
       SUMMARY OF THE INVENTION  
       [0010]     According to a preferred embodiment to the present invention a method and apparatus are disclosed for treating a condition of a patient&#39;s airway. The condition is attributed at least in part to a spacing of tissue from opposing surfaces in the airway. In one embodiment, the method and apparatus include placing a tissue contractor within the tissue. The contractor includes a static end and a tissue in-growth engaging end. The static end is secured to a bony structure adjacent to tissue to be contracted. The tissue in-growth engaging end is secured to the tissue and spaced from the bony structure. A spacing between the tissue engaging end and a bony end is contracted in order to increase the airway geometry.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0011]      FIG. 1  is a side elevation, schematic view of a patient illustrating structure defining an upper airway of the patient and showing an implant according to an embodiment of the present invention positioned within the soft palate and secured to the bony structure of a hard palate and showing a similar implant in the tongue and secured to the bony structure of the jaw;  
         [0012]      FIG. 2  is the view of  FIG. 1  following contracting of the implants in the palate and tongue;  
         [0013]      FIG. 3  is a view similar to that of  FIG. 1  and showing an alternative embodiment of the present invention with implants of the alternative embodiment implanted in both the soft palate and tongue;  
         [0014]      FIG. 4  is the view of  FIG. 3  showing the implants in a contracted state;  
         [0015]      FIG. 5  is a view similar to that of  FIG. 1  and showing a further alternative embodiment of the present invention with an implant of the further alternative embodiment implanted in the tongue;  
         [0016]      FIG. 6  is the view of  FIG. 5  contraction of tissue around the implant;  
         [0017]      FIG. 7  is a top plan view of  FIG. 5  showing an anterior-posterior axis A-P of the tongue;  
         [0018]      FIG. 8  is a view similar to that of  FIG. 1  and showing a yet further alternative embodiment of the present invention with an implants of the yet further alternative embodiment implanted in the tongue;  
         [0019]      FIG. 9  is a view similar to  FIG. 7  showing immediate post-implant of a still further embodiment of the present invention; and  
         [0020]      FIG. 10  is the view of  FIG. 9  following tissue in-growth and resorption of bio-resorbable elements. 
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0021]     With reference now to the various drawing figures in which identical elements are numbered identically throughout, a description of the preferred embodiment of the present invention will now be provided. To facilitate a description and an understanding of the present invention, the afore-mentioned U.S. Pat. Nos. 6,250,307; 6,523,542; 6,431,174; 6,601,584; 5,988,171 and 5,843,021 are hereby incorporated herein by reference.  
         [0022]     With initial reference to  FIG. 1 , a soft palate SP is shown in side elevation view extending from a bony portion of a hard palate HP. The soft palate SP extends rearward to a trailing end TE.  FIG. 1  also illustrates a tongue T with a base TB opposing a pharyngeal wall PW. A jawbone JB is shown at the lower front of the tongue T.  
         [0023]     As a first described embodiment of the present invention, an implant  10  is shown in  FIG. 1  completely implanted within the tongue T. A similar implant  10 ′ is fully implanted in the soft palate SP. As will be apparent, implants  10 ,  10 ′ are functionally and structurally similar differing only in size to facilitate placement in the tongue T and soft palate SP, respectively. As a result, a description of implant  10  will suffice as a description of implant  10 ′ (with similar elements similarly numbered with the addition of an apostrophe to distinguish the implants  10 ,  10 ′). Further, while both implants  10 ,  10 ′ are shown implanted in the same patient, either could be separately implanted.  
         [0024]     The implant  10  includes an elongated member  12  having a tissue in-growth end  14  and a static end  16 . The tissue in-growth end  14  may be any tissue growth inducing material (e.g., felt or PET) to induce growth of tissue into the end  14  to secure the end  14  to surrounding tissue following implantation. The elongated member  12  may be suture material one end secured to the felt  14  and with the static end  16  being a free end of the suture material  12 .  
         [0025]     An anchor  18  (in the form of a treaded eye-bolt) is secured to the jawbone JB. In the case of implant  10 ′, the anchor  18 ′ is secured to the bone of the hard palate. The end  16  is secured to the anchor  18 .  
         [0026]     The end  14  is placed in the tongue near the tongue base TB. A surgeon adjusts a tension of the suture  12 . This causes the tongue base TB to be urged toward the jawbone JB thereby placing the tissue of the tongue in compression. When a desired tension is attained, the surgeon may tie off the static end  16  at the bolt  18  retaining the tissue of the tongue T under tension. This method and apparatus provides a resistance to movement of the tongue base TB toward the pharyngeal wall PW. Similarly, with implant  10 ′, the trailing end TE of the soft palate SP is urged away from the back of the throat and the soft palate SP is prevented from lengthening.  
         [0027]     Placing the implants  10 ,  10 ′ under tension as in  FIG. 1  provides therapy in that the tongue base TB and soft palate trailing end TE are retained from movement toward the pharyngeal wall PW. In addition, at time of initial implantation or thereafter, a surgeon may obtain access to anchors  18 ,  18 ′ and further shorten the length of the elongated member  12  (i.e., by pulling the member  12  through the bolt  18 ,  18 ′) to draw the tongue base or trailing end away from the pharyngeal wall to a new profile. This is illustrated in  FIG. 2  with the contracted profile shown in solid lines TB, TE and contrasted with the original profile shown in phantom lines TB′, TE′.  
         [0028]     Referring to  FIGS. 3 and 4 , an alternative embodiment of the present invention is shown as a implant  10   a  for the tongue T or implant  10   a ′ for the soft palate SP. As with the embodiments of  FIGS. 1 and 2 , implants  10   a ,  10   a ′ are functionally and structurally similar differing only in size to facilitate placement in the tongue and soft palate, respectively. As a result, a description of implant  10   a  will suffice as a description of implant  10   a ′ (with similar elements similarly numbered with the addition of an apostrophe to distinguish the implants  10   a ,  10   a ′). Further, both implants  10   a ,  10   a ′ are shown implanted in the same patient. Either or both implants could be implanted.  
         [0029]     Implant  10   a  includes a tissue engaging end  14   a  and static end  16   a.  As in the embodiment of  FIG. 1 , the static end  16   a  is secured to a hard palate at the eyelet of an eyebolt  18   a  secured to the jawbone JB. Again, as in the embodiment of  FIG. 1 , the tissue-engaging end  14   a  may be any material which encourages tissue in-growth and attachment to tissue. An example of such a material may be PET or a felt material.  
         [0030]     The tissue engaging end  14   a  and the static end  16   a  are connected by a resilient elongated member  12   a  which may be in the form of a spring member such as nitinol or other member which may be stretched to create a bias urging ends  14   a,    16   a  toward one another. Opposing the bias of the spring member  12   a  is a bioresorbable material  20  positioned between the tissue-engaging end  14   a  and the bolt  18   a.    
         [0031]     After placement of the implant  10   a  within the tissue of the tongue and with the end  14   a  near the tongue base TB, the bio-resorbable material  20  will later resorb into the tissue of the tongue T permitting end  14   a  to be urged toward bolt  18   a  by the resilience of the spring  12   a.  This is illustrated in  FIG. 4 , where the contracted implant  10   a  places the tissue of the tongue under tension and urging the tongue base TB away from the pharyngeal wall PW. In  FIG. 4 , the contracted profile of the tongue base TB (and soft palate trailing end TE) is shown in solid lines and the original profile TB′ (TE′) is shown in phantom lines.  
         [0032]      FIGS. 5-7  illustrate a still further embodiment for reducing the tongue base TB. In this embodiment, a sheet  30  of tissue in-growth material (e.g., a sheet of felt with numerous interstitial space) is place in the tongue near the base TB. The sheet  30  is placed beneath the tongue surface and parallel to the base TB substantially covering the area of the tongue base TB. Scarring from the material contracts over time resulting in a reduction in the tongue base as illustrated in  FIG. 6 . To heighten the amount of tongue base reduction, the sheet  30  may be impregnated with a tissue reducing agent (e.g., a sclerosing agent).  
         [0033]      FIGS. 9 and 10  illustrate a further variant of  FIGS. 5-7 . The implant  50  includes three tissue in-growth pads  61 ,  62 ,  63 . A nitinol bar  64  connects the pads  61 - 63  in-line with pad  63  centrally positioned. The bar  64  is pre-stressed to have a central bend shown in  FIG. 10 . Bio-resorbable sleeves  65 ,  66  hold the bar  64  in a straight line against the bias of bar  64  as in  FIG. 9 . The implant  50  is implanted as shown in  FIG. 9  with the straight bar  64  parallel to the tongue base TB. After implantation, tissue grows into pads  61 - 63 . After the time period of in-growth, the sleeves resorb as in  FIG. 10 . With the sleeves resorbed, the bar  64  bends to its pre-stressed shape. The tongue base moves with the pad  63  to reposition the tongue base (illustrated in  FIG. 10  as the shift from TB′ to TB).  
         [0034]      FIG. 8  illustrates a still further embodiment of the invention for reducing the tongue base. Certain muscles of the tongue (particularly, the genioglossus muscles) radiate from the jawbone JB to the tongue surface as illustrated by lines A in  FIG. 8 . Contacting implants  40  identical to those in  FIGS. 46 and 47  of U.S. Pat. No. 6,601,584 are placed with a contracting axis (the axis between tissue in-growth ends  14   a ′—identical to ends  102   b  in  FIGS. 46, 47  of the &#39;584 patent) are placed in the tongue in-line with the muscle radiating lines A. Alternatively, the contracting implant  40  may be of the construction shown in  FIGS. 48 and 49  of the &#39;584 patent. As the implants contract over time, they urge the tongue from collapsing toward the pharyngeal wall. In lieu of contracting implants, the elongated implants can be static implants such as implants shown in  FIG. 11  of U.S. Pat. No. 6,250,307 and labeled  20 .  
         [0035]     The foregoing describes numerous embodiments of an invention for an implant for the tongue and soft palate to restrict tissue movement toward the pharyngeal wall. Having described the invention, alternatives and embodiments may occur to one of skill in the art. It is intended that such modifications and equivalents shall be included within the scope of the following claims.