Abstract:
The present invention relates to a surgical retractor. The surgical retractor may include a handle having a longitudinal axis and proximal and distal ends, a first coupling mechanism adjacent the proximal end of the handle, and a blade member having a proximal end and a distal end. The blade member may have a coupling element, and the coupling element may be configured and dimensioned to connect with the first coupling mechanism. The present invention also relates to methods for treating bone.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 60/415,135, filed Oct. 2, 2002, the entire contents of which are expressly incorporated herein by reference thereto. 
    
    
     FIELD OF THE INVENTION 
     This invention relates to medical instruments and, more particularly, to surgical retractors. The invention also relates to surgical procedures and, more particularly, to surgical procedures for treating bone. 
     BACKGROUND OF THE INVENTION 
     During a surgical procedure, it may be appropriate to prevent trauma to the patient and to attempt to reduce damage to tissue surrounding a surgical site. Surgeons, therefore, may make appropriately sized incisions when performing a surgical procedure. A surgeon performing surgery may further prefer a clear and/or stabilized view of the operating field. Retractors may be used during surgery to open an incision and provide a view of the field of the operation. 
     SUMMARY OF THE INVENTION 
     The present invention relates to a surgical retractor having, in an exemplary embodiment, a primary handle having a distal end and a proximal end. The surgical retractor may also have a first coupling mechanism located at the proximal end of the primary handle, and in addition may also have a second coupling mechanism located at the proximal end of the primary handle. Located at the distal end of the primary handle, in an exemplary embodiment, may be auxiliary handle. The auxiliary handle may provide an additional surface for gripping the retractor. The distal end of the primary handle may further include a bore having a threaded portion which may be configured to couple the auxiliary and primary handles. 
     In one development, the first coupling mechanism may be designed to secure interchangeable retractor blades to the handle, and the second coupling mechanism may be designed to secure a secondary surgical instrument, such as a light pipe or endoscope-type instrument, to the primary handle at a user desired orientation. 
     In an exemplary embodiment, the first coupling mechanism may be comprised of a rotatable knob disposed within the handle. The knob may have a bore which extends axially from approximately the center of the knob to an upper surface of the knob. The bore, may be threaded and designed to receive a connector located on the bottom of a retractor blade. In another development, a shoulder may be located on the upper surface of the primary handle to aid in coupling the retractor blade to the primary handle. The shoulder located on the upper surface of the primary handle may abut the back end of the retractor blade and prevent the retractor blade from rotating with respect to the handle, once the blade is coupled to the handle. In an illustrative embodiment, the shoulder may have a protrusion for engaging a notch that may be present at the back end of the retractor blade. 
     In another development, the second coupling mechanism may include a knob, an inner sleeve, and a clamping member. The knob may have a bore which extends axially from approximately the center of the knob to an upper surface of the knob. An inner sleeve may surround a portion of the clamping member. An upper surface of the inner sleeve may be configured and dimensioned to operatively interface with the clamping member. In an illustrative embodiment, the clamping member may have, near its lower surface, a shaft that may be designed to engage the bore in the knob. The clamping member may have a through-hole near its upper surface for receiving a secondary surgical instrument. In an exemplary embodiment, the knob, the through-hole located in the clamping member, and the upper surface of the inner sleeve operatively interface to clamp the secondary surgical instrument in place. 
     In another development, the retractor blade may be substantially straight along its longitudinal length from the distal end to near the proximal end. The blade may include a transverse concavity. In an illustrative embodiment, the proximal end of the retractor blade may include a notch for engagement with the protrusion located on the retractor handle shoulder. Located adjacent the proximal end of the blade, may be a connector that extends downwardly from the blade. The distal end of the retractor blade may be straight. Alternatively, the distal end of the blade may have a first curved portion. Also, at the end of the first curved portion, near the tip of the distal end of the blade, may be a second curved portion which has a generally hook-like shape. In another illustrative embodiment, the blade may be straight near the distal end. In another illustrative embodiment, located near the distal end of the blade may be an aperture extending from the upper surface of the blade to the lower surface of the blade. 
     In another exemplary embodiment, the surgical retractor may include a handle having a longitudinal axis and proximal and distal ends, a first coupling mechanism adjacent the proximal end of the handle, and a blade member having a proximal end and a distal end. The blade member may further have a coupling element, and the coupling element may be configured and dimensioned to connect with the first coupling mechanism. 
     In another development, the first coupling mechanism may have a knob having a bore. The bore may be transverse to the longitudinal axis of the handle. In an illustrative embodiment, the knob may be coupled to the handle by a pin. For instance, the pin may contact the bore, the bore may form an axial bore, and the pin may form an axle for the knob so the knob may rotate about the axle. In an illustrative embodiment, the bore may also extend from a first outer surface to a second outer surface of the knob. The bore may be further adapted to engage the coupling element of the blade member. For example, and without limitation, the coupling element may have a shaft. In one such embodiment, the shaft and the bore may have mating threads for releasably advancing the shaft within the bore. In an another development it may also be possible that the handle may have an opening that is configured and dimensioned to receive the knob. 
     In another development, the handle may have a surface for supporting the blade member. In an illustrative embodiment, the surface may have a curved portion. For example, and without limitation, the curved portion may be concave. In another example, the surface may have a contour that is configured and dimensioned to generally correspond with a portion of the blade member. In another development, the blade member may have a contour that is configured and dimensioned to generally correspond with a portion of the handle. For example, the blade member may have a longitudinal axis and a contour that defines a transverse concavity along the longitudinal axis of the blade member. 
     In another development, the blade member may also have an aperture near the distal end of the blade. In an illustrative embodiment, the aperture may be configured and dimensioned to allow a surgical tool to pass through the aperture. Examples of such a tool include but are not limited to a trochar, a cannula, an implant diver (such as a screw driver), a drill, and a syringe. In addition, the aperture may be configured and dimensioned to allow an orthopedic implant to pass through the aperture. Examples of such implants include, without limitation, a bone plate, a fastener (e.g., a screw, pin, nail, wire, or suture), or a bone void filler material (e.g., a bone cement, a bone cement substitute, a bone graft, or an allograft). 
     In another development, the distal end of the blade member may also have a structure for stabilizing the retractor blade against bone. For instance, the distal end of the blade member may have a hook-shape and/or projection. In one example, the structure includes a hook-shape that may generally form a “C”-shape. In another example, the structure includes a hook-shape that may generally from an “L”-shape. 
     In another development, the retractor may have a second coupling mechanism located on the handle for coupling a second surgical instrument to the handle. For instance, the second surgical instrument may be an endoscope or light source. An endoscope, for example, may be positioned to provide a view of the distal end of the retractor blade. The retractor may therefore include an endoscope or light source secured to the handle. In such an embodiment, the endoscope or light source may be positioned to view/light the distal end of the retractor blade. 
     In an exemplary embodiment, the second coupling mechanism may have a coupling member that may be located near the proximal end of the handle. The coupling member may be configured and dimension to be received within the handle. In an illustrative example, the coupling member may be telescopically received within the handle. The coupling member may or may not be spaced from the handle. The coupling member may contact a second member, for example, a sleeve. The second member may contact the handle. The coupling member and the second member may also be operatively associated to fixate a second surgical instrument with respect to the handle. For instance, a coupling member may be configured and dimensioned to translate, rotate, or translate and rotate with respect to a second member. In an illustrative embodiment, the coupling member may have a recess adapted to receive a portion of the second surgical instrument. The recess, for example, may have an inner surface, and the inner surface may be adapted to secure the portion of the second surgical instrument to the second member. In an exemplary embodiment, the inner surface of the recess may clamp the portion of the second surgical instrument to the second member. 
     In another development, the second coupling mechanism may have a protuberance, such as a knob, for controlling movement of the coupling member with respect to the handle. In an illustrative embodiment, the protuberance may be connected to the handle. For instance, the protuberance may include a structure (e.g., a flange, projection recess, groove, slot latch, rib, lock, or coupling) for securing the protuberance to the handle. 
     In another development, the protuberance may also have a structure (e.g., a flange, projection recess, groove, slot latch, rib, lock, or coupling) for securing the protuberance to the coupling member. In an illustrative embodiment, the protuberance may have a bore, and the bore may be configured and dimensioned to connect with the coupling member. The bore and the coupling member may also be operatively associated to provide controlled relative movement between the protuberance and the coupling member. For example, the bore and the coupling member may have mating threads. 
     In another development, the retractor may also include another surgical instrument having a coupling element configured and dimensioned to connect with the first coupling mechanism. In an illustrative embodiment, the other surgical instrument may include on or more retractor blades having similar or different shape. For instance, the retractor blades may have varying length, varying width, and/or varying degrees of concavity so that an operator may select a blade most suited for a clinical need. 
     In another development, the retractor may further include a second handle. In an illustrative embodiment, the second handle may be transverse to the longitudinal axis. 
     In yet another development, the retractor may be provided in a kit with other tools. For example, one retractor kit might include one or more primary handles, each handle having a proximal and distal end. The kit may further include one or more blade members each having a proximal end, a distal end, and a shaft portion proximate the proximal end of the blade. Each primary handle may have a first coupling mechanism located proximate the proximal end of the handle for coupling the blade to the handle. The coupling mechanism may be designed and configured to releasably couple with the shaft portion of the blade. The kit may also include one or more auxiliary handles. Each auxiliary handle may be designed and configured to couple proximate the distal end of at least one of the primary handles. 
     In use, the retractor may be used, for example, in surgical procedures for treating bone. For instance, the surgical retractor may be used by positioning an endoscope with respect to the retractor blade for viewing a surgical site that may be accessed in part by using the retractor to retract soft tissue from or near bone. In an illustrative example, an incision may be made in soft tissue and the soft tissue fascia may be elevated off a bone segment proximate the surgical site. The retractor blade may be passed through the incision. Fascia may be retracted off the bone segment with the retractor blade to form a cavity. A portion of the retractor blade may be placed in contact with—and/or may circumvent at least in part—a portion of the bone segment. The retractor blade may be stabilized on the bone segment. The bone segment may be viewed through the endoscope. A surgical procedure may be performed proximate the bone segment. The surgical procedure may also involve securing the endoscope with respect to the retractor blade. 
     In another development, the surgical procedure may involve passing an orthopedic implant through the cavity. Examples of such implants include, without limitation, a bone plate, a fastener (e.g., a screw, pin, nail, wire, or suture), or a bone void filler material (e.g., a bone cement, a bone cement substitute, a bone graft, or an allograft). In another development, a part of the surgical procedure may be performed through an aperture of the retractor blade. For instance, the surgical procedure may involve passing a surgical tool through an aperture of the retractor blade. Examples of surgical tools that may be passed through the aperture (in whole or in part) may include, without limitation, a drill, a burr, a syringe, and/or a cannula. 
     In another development, a surgical procedure may involve passing an orthopedic implant through the aperture. An suitable implant may be passed separate from or together with a surgical tool. Examples of such implants include, without limitation, a bone plate, a fastener (e.g., a screw, pin, nail, wire, or suture), or a bone void filler material (e.g., a bone cement, a bone cement substitute, a bone graft, or an allograft). 
     In yet another development, the surgical procedure may include securing an orthopedic implant to the bone segment. For instance, the surgical procedure may include fixating a fracture proximate the bone segment. In an illustrative example, the bone segment may be a condylar neck. 
     In yet another development, the surgical procedure may include performing an orthognathic procedure. 
     In yet another development, the surgical procedure may include a condylar grafting procedure. For instance, the grafting procedure may involve a bone segment of a ramus and/or a bone segment of the condylar neck and/or head. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       To facilitate an understanding of and for the purpose of illustrating the present invention, exemplary and preferred features and embodiments are disclosed in the accompanying drawings, it being understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown, and wherein similar reference characters denote similar elements throughout the several views, and wherein: 
         FIG. 1  is a perspective view of a first embodiment of a retractor according to the present invention; 
         FIG. 2  is a side view of the handle of the retractor of  FIG. 1 ; 
         FIG. 3  is a cross-sectional view of a portion of the handle of  FIG. 2  taken along line  3 - 3 ; 
         FIG. 4  is a cross-sectional view of a portion of the handle of  FIG. 2  taken along line  4 - 4 ; 
         FIG. 5  is a side view of a first embodiment of an interchangeable retractor blade according to the present invention; 
         FIG. 6  is a top view of the interchangeable retractor blade of  FIG. 5 ; 
         FIG. 7  is a top view of a second embodiment of an interchangeable retractor blade according to the present invention; and 
         FIG. 8  is a perspective view of a third embodiment of an interchangeable retractor blade according to the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring to the accompanying drawings, preferred embodiments and features of the surgical retractor will be described in detail. It is to be noted however that these descriptions of specific embodiments and features are merely illustrative. It is contemplated that one or more features or elements of the various embodiments may be combined or used singularly, and that modifications of the various embodiments, as well as other embodiments are contemplated and will be apparent to those persons skilled in the art. 
     Referring initially to  FIG. 1 , a perspective view of an exemplary first embodiment of a retractor  10  is shown. Retractor  10 , preferably, has a primary handle  12  having a longitudinal axis  11 , a proximal end  14  and a distal end  16 . As shown in  FIGS. 1 and 2 , handle  12 , preferably, is generally arcuate with a generally rectangular cross-sectional shape and is designed to comfortably interface with the operator&#39;s fingers and hands. Although handle  12  is shown as being arcuate with a generally rectangular cross-sectional shape, handle  12  may be any shape, preferably a shape that conforms ergonomically and comfortably with an operator&#39;s fingers and hands. For example, handle  12  may be rectangular, cylindrical, arcuate with a cylindrical shape, octagonal, arcuate with an octagonal shape, hexagonal, or arcuate with a hexagonal shape. Handle  12  may also be straight instead of the curved, arcuate shape as shown. 
     In an exemplary embodiment, distal end  16  of primary handle  12 , handle  12  may include a bore  18  (not shown). Bore  18  preferably extends transverse to the longitudinal axis of handle  12  and may extend partially through handle  12 , from front end  13  to generally the center of handle  12  or from back end  15  to generally the center of handle  12 . In another exemplary embodiment, bore  18  may extend completely through handle  12 , from front end  13  to back end  15 . Bore  18  preferably includes threading for receiving a threaded shaft  20  (not shown) of an auxiliary handle  22 . Depending on which side of handle  12  bore  18  is located, or if bore  18  is a through-bore, bore  18  will allow coupling of auxiliary handle  22  to handle  12  at either the front end  13  or the back end  15  of handle  12 . Accordingly, depending on the holding surface required and/or the position of the operator, auxiliary handle  22  may be coupled to handle  12  extending in a direction as shown in  FIG. 1 , or auxiliary handle  22  may be coupled to handle  12  extending in a direction opposite to the direction shown in  FIG. 1 . It will be appreciated that auxiliary handle  22 , in the embodiment, shown may be releasably coupled and uncoupled to handle  12 , and further that auxiliary handle  22  maybe fixedly coupled to handle  12 . 
     In addition, although auxiliary handle  22  is generally oriented so that longitudinal axis  23  is generally at an angle of about 93° to about 105° with respect to longitudinal axis  11  of handle  12 , it can be appreciated that auxiliary handle  22  can be oriented so that it is generally perpendicular to handle  12 . 
     Turning to  FIG. 1 , auxiliary handle  22  aids in the further support of retractor  10  by providing the operator an additional surface for gripping retractor  10 . Auxiliary handle  22  preferably has a generally cylindrical shape with a larger medial diameter and smaller lateral diameters. This shape provides for comfortable gripping of handle  22 . Although handle  22  is shown as generally cylindrical, handle  12  may be any shape, preferably a shape that conforms ergonomically and comfortably with an operator&#39;s fingers and hands. For example, handle  12  may be rectangular, cylindrical, octagonal, or hexagonal. Preferably located at a lateral end of auxiliary handle  22 , threaded shaft  20  may be integral with auxiliary handle  22  or may be coupled to auxiliary handle  22 . Alternative to threaded engagement, other methods of coupling auxiliary handle  22  to handle  12  have been contemplated. For example, handle  22  may be coupled to handle  12  via an interference fit or similar coupling. 
     Located near proximal end  14  of handle  12  is a coupling mechanism  24  designed to secure interchangeable retractor blades to handle  12 . As shown in  FIG. 3 , in an exemplary embodiment, coupling  24  comprises a knob  26  having an axial bore  28 . Knob  26  is preferably rotatably coupled to handle  12  via axle  32 . In an exemplary embodiment, axial bore  28  extends from approximately the center of knob  26  to the upper surface of knob  26  where it axially aligns with opening  34  in handle  12 . Opening  34  extends from the cavity portion  35  of handle  12  where knob  26  is disposed to an upper surface  36  on handle  12 . Axial bore  28  is preferably threaded. Preferably, knob  26  may be knurled or have some other form of texturing on its outside surface to enhance grip. In an exemplary embodiment, a shoulder  30  may also be included on handle  12  to aid in the coupling of an interchangeable retractor blade to handle  12 . 
     Referring to  FIGS. 5 and 6 , an exemplary interchangeable retractor blade  56  is shown. In an exemplary embodiment, the length of blade  56  may range from about 75 mm to about 150 mm and, preferably, range from about 95 mm to about 125 mm and the width of blade  56  may range from about 8 mm to about 25 mm and, preferably, range from about 10 mm to about 20 mm. 
     Blade  56  has a longitudinal axis  58 , a proximal end  60 , and a distal end  62 . Located near proximal end  60 , on the underside of blade  56 , is a shaft  64 . Shaft  64  is preferably threaded and is designed to engage axial bore  28  of knob  26  via opening  34  in upper surface  36  of handle  12 . In an exemplary embodiment, the back end  63  of blade  56  may be straight to abut shoulder  30 . In another exemplary embodiment, blade  56  may include a notch  65  (shown in  FIG. 7 ) for engagement with a protrusion located on handle  12 , as discussed earlier. 
     The back end  63  cooperates with shoulder  30  to position blade  56  on handle  12 . The back end  63  of blade  12  and shoulder  30  on handle  12  may also cooperate to prevent blade  56  from rotating or pivoting on handle  12 . Notch  65  on blade  56  and the protrusion on handle  12  also cooperate to position blade  56  on handle  12 , and may also prevent blade  56  from rotating or pivoting on handle  12 . 
     The proximal end  60  of blade  56  extends generally perpendicular to proximal end  14  of primary handle  12 . The auxiliary handle  22  is preferably arranged so that it extends along an axis  23  that is approximately parallel to the longitudinal axis  58  of blade  56 . 
     Referring to  FIGS. 1 and 2 , in an exemplary embodiment, located near proximal end  14  of handle  12  is another coupling mechanism  38  designed to secure a secondary surgical instrument, such as a light pipe or endoscope-type instrument, to handle  12 . Coupling mechanism  38  and coupling mechanism  24  preferably operate independently of each other. Accordingly, coupling mechanism  38  may be used with a secondary surgical instrument without using coupling mechanism  24  and coupling mechanism  24  may be used with an interchangeable retractor blade without using coupling mechanism  38 . 
     As shown in  FIG. 4 , in an exemplary embodiment, coupling mechanism  38  extends distally beyond the back end  63  of retractor blade  56 . Coupling mechanism  38  comprises knob  40 , an inner sleeve  42 , and a clamping member  44 . Knob  40  includes an axial bore  50  which preferably is threaded and extends from approximately the center of knob  40  to the upper surface of knob  40 . Preferably, knob  40  may be knurled or have some other form of texturing on its outside surface to enhance grip. Inner sleeve  42  preferably surrounds a portion of clamping member  44  and has an upper surface  46  which is designed to operatively interface with clamping member  44  to lock a secondary surgical instrument in place, as discussed below. Clamping member  44  preferably includes a through-hole  48  located near its upper end for receiving a secondary surgical instrument and a shaft  52  extending downwardly from its lower end. Shaft  52  is preferably threaded and threadably engages axial bore  50  in knob  40 . 
     As can be seen in  FIGS. 1 and 4 , handle  12  surrounds a portion of knob  40  and a portion of inner sleeve  42 , which, in turn, surrounds a portion of clamping member  44 . Preferably, sleeve  42  and clamping member  44  can rotate with respect to handle  12 , but remain coupled to handle  12 . In an exemplary embodiment sleeve  42 , and clamping member  44  remain coupled to handle  12  via a pin  54 , however, other methods of coupling may be used, such as, for example, snap-fitting. In another exemplary embodiment, handle  12  surrounds a portion of knob  40 , a portion of inner sleeve  42 , and a portion of clamping member  44 , however, handle  12  surrounds these elements via an elongated opening. The elongated opening allows rotation of knob  40 , sleeve  42  and clamping member  44  with respect to handle  12  and allows translation of knob  40 , sleeve  42  and clamping member  44  with respect to handle  12 . 
     As mentioned earlier, coupling mechanism  38  is designed to secure a secondary surgical instrument, such as a light pipe or endoscope-type instrument, to handle  12 . In an exemplary manner of use, the operator of the retractor selects the desired surgical instrument and the instrument is introduced into through-hole  48  in clamping member  44  in a direction generally transverse to the longitudinal axis of handle  12 . Clamping member  44  may be rotated to adjust the orientation of the instrument. In the other exemplary embodiment, clamping member  44  may be rotated or translated to further adjust the orientation of the instrument. Once the desired orientation of the instrument is achieved, knob  40  is rotated causing the threads in axial bore  52  to engage the threads on threaded shaft  52  of clamping member  44  to advance the threaded shaft  50  of clamping member  44  into axial bore  50 . As threaded shaft  52  advances into axial bore  50 , clamping member  44  moves downwardly with respect to inner sleeve  42 . Since the surgical instrument passes through through-hole  48 , as clamping member  44  moves downwardly with respect to inner sleeve  42 , the surgical instrument becomes locked between the upper surface of through-hole  48  and upper surface  46  of inner sleeve  42 . Further rotation of knob  40  results in the locking of inner sleeve  42  and clamping member  44  with respect to handle  12  since clamping member  44  moves downwardly with inner sleeve  42  until clamping member  44  abuts inner sleeve  42  which in turn abuts handle  12 . 
     Retractor blade  56  may be configured in many different sizes and shapes. In a first exemplary embodiment shown in  FIGS. 5 and 6 , blade  56  has a first curved portion  66  having a distal end  68  and a proximal end  70  located at the distal end  62  of blade  56 . Curved portion  66  preferably extends at an angle θ from longitudinal axis  58 . In an exemplary embodiment, θ is between about 90° and about 150° and, preferably, is between about 110° and about 125°. Located near distal end  68  of curved portion  66  is a second curved portion  72 . In an exemplary embodiment, second curved portion  72  has a generally hook-like shape that is semi-circular in shape with a radius of between about 1.5 mm to about 4 mm. Although shown as having a hook-shape, other shapes for curved portion  68  have also been contemplated, including, for example a truncated “C”-shape, and a “L” shape. 
     Blade  56  is preferably generally straight along longitudinal axis  58  from proximal end  60  to near distal end  62 . As can best be seen in  FIG. 8 , in an exemplary embodiment, blade  56  may have a slight transverse concavity, for aiding in retraction, along its longitudinal length. The radius of the concavity of blade  56  preferably ranges from about 10 mm to about 20 mm radius. Further, in an exemplary embodiment, the width of blade  56  may vary along the longitudinal length of blade  56 . 
     Referring to  FIG. 7 , an alternate exemplary embodiment of an interchangeable retractor blade  74  is shown. In general, most of the structure of blade  74  is similar or comparable to the structure of blade  56 . Accordingly, the equivalent structures of blade  74  have been numbered the same as blade  56  and discussion of the similar components and features is not believed necessary. In this exemplary embodiment, an aperture  76  which extends through blade  74  from the upper surface to the lower surface is included near distal end  62  of blade  74 . Aperture  76  preferably is configured and dimensioned to allow an operator to view or access subject matter located behind blade  74 . 
     Turning now to  FIG. 8 , another exemplary embodiment of an interchangeable blade  78  is shown. In general, most of the structure of blade  78  is similar or comparable to the structure of blade  56 . Accordingly, the equivalent structures of blade  78  have been numbered the same as blade  56  and discussion of the similar components and features is not believed necessary. In this particular embodiment, at distal end  62  of blade  78 , instead of having first and second curved portions  66  and  72 , blade  78  only has a first curved portion  66 . 
     Referring back to  FIGS. 1-3 , as mentioned earlier, coupling mechanism  24  is designed to secure interchangeable retractor blade  56 ,  74 ,  78  to handle  12 . In an exemplary manner of use, the operator of the retractor  10  selects a desired interchangeable retractor blade  56 ,  74 ,  78 . The shaft  64  of the selected retractor blade  56 ,  74 ,  78  is introduced to axial bore  28  through opening  34  located on the upper surface  36  of handle  12 . Knob  28  is rotated, via its edges, which extend radially outwardly from the sides of handle  12 , causing the threads in axial bore  28  to engage the threads on the threaded shaft of retractor blade  56 ,  74 ,  78 , to advance the threaded shaft of retractor blade  56 ,  74 ,  78  into axial bore  28 . Preferably, knob  28  is rotated until a lower surface of the retractor blade  56 ,  74 ,  78  is flush with upper surface  36  of handle  12 . In an exemplary embodiment, shoulder  30 , located on upper surface  36  of handle  12 , serves to abut the end of the retractor blade  56 ,  74 ,  78  preventing the blade from rotating with respect to handle  12  once it is coupled to handle  12 . In another exemplary embodiment, shoulder  30  may have a protrusion (not shown) designed to engage a notch located in the retractor blade  56 ,  74 ,  78 . 
     Although, in an exemplary embodiment, retractor blade  56 ,  74 ,  78  is threadably engaged to handle  12 , other methods of coupling are contemplated. For example, retractor blade  56  can be coupled to handle  12  via an interference fit or a snap-fit. 
     Retractor blades  56 ,  74 ,  78  may be used in a variety of surgical procedures. One exemplary use of retractor  10  with retractor blade  56  is a maxillofacial procedure involving the mandible. Blade  56 , in an exemplary embodiment, may include second curved portion  68  which is shaped to engage the ramus and condylar regions of the lower mandible. 
     As discussed earlier, in an exemplary embodiment, coupling mechanism  24  and coupling mechanism  38  are independently operable. Thus, primary handle  12  may include coupling mechanism  24 , but not coupling mechanism  38 . However, in an exemplary use, both coupling mechanisms may be used. Accordingly, in an exemplary use, an operator will use coupling mechanism  24  to couple retractor blade  56 ,  74 ,  78  to handle  12  and will use coupling mechanism  38  to couple a secondary surgical instrument to handle  12 . Coupling mechanisms  24 ,  38  are configured and designed on primary handle  12  to permit the retractor blade and the secondary surgical instrument, i.e. a light cable or endoscope-type instrument, to interact in a manner such that the retractor blade and the secondary surgical instruments can perform their respective functions while avoiding interference with each other and the surgical procedure. In an exemplary manner of use, an operator selects the desired retractor blade  56 ,  74 ,  78  and couples blade  56 ,  74 ,  78  to handle  12  via coupling mechanism  24 . The operator then selects the desired secondary surgical instrument, such as an endoscope, and couples the endoscope to handle  12  via coupling mechanism  38 . Coupling mechanism  38  allows the orientation of the secondary surgical instrument to be adjusted. Accordingly, the operator will adjust the secondary surgical instrument to the desired orientation before locking it in place via coupling mechanism  38 . In an exemplary use, retractor blade  56 ,  74 ,  78  will be situated generally parallel to the secondary surgical instrument, thereby preventing interference between the retractor blade and the secondary surgical instrument and avoiding interference with the surgical procedure. 
     The interchangeable retractor blades and handle may be packaged and sold as a kit which may include one or more retractor blades, one or more primary handles  12 , one or more auxiliary handles  22 , and potentially other accessories. 
     While various descriptions of the present invention are described above, it should be understood that the various features can be used singly or in combination thereof. Therefore, this invention is not to be limited to the specific preferred embodiments depicted herein. Further, it should be understood that variations and modifications within the spirit and scope of the invention may occur to those skilled in the art to which the invention pertains. For example, the interchangeable blades of the surgical retractor disclosed herein may not include any curvature at the distal portion thereof, and thus be a straight blade. Accordingly, all expedient modifications readily attainable by one versed in the art from the disclosure set forth herein that are within the scope and spirit of the present invention are to be included as further embodiments of the present invention. The scope of the present invention is accordingly defined as set forth in the appended claims.