Patent Publication Number: US-2009234194-A1

Title: Tongue depressor

Description:
RELATED APPLICATION 
     This application claims the benefit of U.S. Provisional Application Ser. No. 60/763,007 filed Jan. 28, 2006, the entire contents of which are incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     Embodiments of the present invention relate to medical devices and procedures for controlling the position of tongue and/or ventilation tubes during surgery. 
     BACKGROUND OF THE INVENTION 
     Tonsillectomy and adenoidectomy are widely performed operations. Current standard technique uses a “mouth gag”. This mouth gag consists of two parts: a metal tongue depressor and a ring shaped device that holds the tongue depressor in position. The tongue depressor portion of the mouth gag is designed to depress the tongue during the operation and afford the surgeon hands free exposure to the oral cavity and oropharynx. Because the patients undergoing this operation are under general anesthesia, there is also an endotracheal tube providing ventilation. The endotracheal tube needs to be held out of the way during surgery. 
     There are currently several designs of tongue depressors in use, including the widely used Davis and Doughty varieties. The Davis tonsil mouth gag and tongue depressor is L-shaped with a vertical portion and a tongue portion. The vertical portion does not touch the patient and attaches to the rest of the mouth gag device. The tongue portion is designed to depress the tongue. The tongue portion is made of stainless steel and has a midline groove running its length. The groove depresses the endotracheal tube onto the middle of the tongue during the operation thereby holding it out of the surgical field. 
     In the Doughty variety, a midline slit in the tongue portion depresses the endotracheal tube instead of a groove. Neither the Davis nor the Doughty varieties fits well with laryngeal mask airways (LMAs) being used for general anesthesia during tonsillectomy procedures, causing problems with surgical access and safe patient ventilation. 
     The present mouth gags are associated with several problems. During insertion, these devices rub against LMA breathing tubes in a way that coils, kinks or displaces the LMA, causing difficult or inadequate patient ventilation. During removal, these mouth gags trap the breathing tubes in their grooves making accidental removal a dangerous possibility. The groove in the Davis mouth gag bulges into the surgical field at times, obscuring the surgeon&#39;s view and access to portions of the throat during surgery, especially when linear instruments, such as micro-debraders are used. 
     SUMMARY OF THE INVENTION 
     Aspects of the present invention feature devices and methods for depressing the tongue during surgical procedures. One aspect of the present invention provides a device for depressing the tongue comprising a first planar element, second planar element and at least one bridge element. The first planar element and second planar element each have a top surface, a bottom surface, an inside edge, an outside edge, a front end, a back end, a length and a width. The length from the front end to the back end corresponds to the distance between the front exterior of the oral cavity to an area of the tonsils. The bottom surface is for placing on the top of the tongue with the front end into the oral cavity and the back end toward the exterior of the oral cavity. The top surface creates a chamber with the palate of the patient for viewing and performing surgical procedures. The outside edges of the first planar element and the second planar element are for positioning buccally and the inside edges of the first and second planar elements are facing each other are spaced apart a distance sized for at least one of the ventilation means selected from the group of laryngeal mask airway devices and endotracheal tubes to create a channel space. Each one bridge element is affixed to the first planar element and the second planar element spanning the channel space, and allowing at least fifty percent of the area of the channel space open. 
     The open channel space allows the surgeon to view the ventilation means during use of the device. During insertion and removal, the surgeon may view the ventilation means to insure that the ventilation means is properly positioned. The surgeon can also manually move or position the ventilation means to accommodate the needs of the surgical procedure. The one or more bridge elements allow the surgeon to have substantial view of the surgical field. 
     As used herein, the term “corresponds” means approximately equal to. That is, by way of example, the length of the first and second planar elements is approximately equal to the distance from the front of the oral cavity to the area around the tonsils. The area around the tonsils includes the area to the front of the tonsils and the area behind the tonsils. 
     Preferably, the device has at least two bridge elements. And, preferably, each bridge element has a length and a width. Each bridge element is affixed to each top surface of the first and second planar elements. And, preferably, each bridge element is an arch extending toward the palate to allow ventilation means to be retained between the tongue, the inside edges of the first and second planar elements, and the bridge element. Thus, the bridge element forms an arc of a partial or semi- or half circle corresponding generally to the dimensions of the ventilation means. 
     A preferred width is one to ten millimeters, and, more preferably, two to four millimeters. The length corresponds to the width of the ventilation means used. Thus, the arc of a partial, semi- or half circle has a diameter of four to twenty-five millimeters, and, even more preferably, ten to twenty millimeters. The inside edges of the first planar element and the second planar element are thus spaced in a range of approximately four to twenty-five millimeters and, preferably, ten to twenty millimeters. 
     Preferably, where there are two bridge elements, the forward bridge element, furthest into the oral cavity, is approximately fifteen to thirty-five millimeters from the front end, and, more preferably, about twenty to about thirty millimeters from the front end. The back bridge element, closest to the lips, is about ten to about thirty millimeters from the back end, and, more preferably, about fifteen to about twenty-five millimeters from the back end. 
     Preferably, each first planar element and each second planar element have a straight portion and a curved portion. The curved portion is toward the front end and corresponds to the curvature of the tongue moving downward into the larynx. The straight portion is toward the back edge of each planar element. Preferably, the curved portion creates an arc from a distance in the range of approximately about ten to about twenty-five millimeters from the front end. And, the front edge is depressed a distance in the range of about five to about fifteen millimeters from a plane formed by the straight portion. 
     Preferably, the device has a handle affixed to one or more of the first planar element and the second planar element. The handle extends from the back end of at least one of the first and second planar elements to allow the surgeon to firmly grasp the device for positioning in the oral cavity. A preferred handle is an extension of one of the first planar element and the second planar element. The handle extends at an angle from about 45 to about 135 degrees from at least one of the bottom surfaces to place the handle away from the surgical field. Preferably, the handle rests on a surface place on the patient&#39;s chest when the first planar element and second planar element are positioned against the tongue in the oral cavity. 
     Preferably, the device has a hook for hanging on a surgical apparatus. In a preferred embodiment, the hook is part of the handle. 
     A further aspect of the present invention provides a method for depressing the tongue. The method comprises the step of providing a device having a first planar element, second planar element and at least one bridge element. The first planar element and second planar element each have a top surface, a bottom surface, an inside edge, an outside edge, a front end, a back end, a length and a width. The length is the distance from the front end to the back end and corresponds to the distance between the front exterior of the oral cavity and an area of the tonsils. The bottom surface is for placing on the top of the tongue with the front edge into the oral cavity and the back edge toward the exterior of the oral cavity. The top surface is for creating a chamber with the palate of the patient for viewing and performing surgical procedures. The outside edge of the first planar element and the second planar element is for positioning buccally, with the inside edges facing each other. The inside edges are spaced apart a distance sized for at least one of the ventilation means selected from the group of laryngeal mask airway devices and endotracheal tubes to create a channel space. The bridge element is affixed to the first planar element and the second planar element spanning the channel space. In one embodiment, the bridging element allows at least about fifty percent of the area of the channel space to be open. The method further comprises the step of fitting the device in the oral cavity to depress the tongue. 
     The fitting of the device is facilitated with a handle extending from at least one of the first and second planar elements. In one embodiment, the device may be stored conveniently with a hanging means to be available to a surgeon for next use. 
     These and other features and advantages of the present invention will be apparent to those skilled in the art upon viewing the accompanying drawings and reading the detailed description of the invention that follow. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS  
         FIG. 1  is a side, slightly elevated, view of a device embodying features of the present invention; 
         FIG. 2  is a front view of a device embodying features of the present invention; and, 
         FIG. 3  is a top view of a device embodying features of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
     Embodiments of the present invention will be described in detail as a device and method for depressing the tongue by surgeons in performing surgical operations. Those skilled in the art will recognize that embodiments of the present invention have utility in other fields as well. For example, without limitation, embodiments of the present invention have application for veterinary procedures. However, it is readily understood that the dimensions of the device will need to be adjusted for anatomical differences and that such adjustments are well within the skill of those skilled in the art. Further, it is understood that the dimensions set forth in the present disclosure are directed to normal values for adults. The dimensions can be altered for application for infants, toddlers and children. 
     Turning now to  FIG. 1 , a device for depressing the tongue embodying features of the present invention is depicted, generally designated by numeral  11 . Device  11  has a first planar element  15 , second planar element  17  and at least one bridge element of which two, designated by numerals  19  and  21 , are depicted. The device  11  is a surgical instrument and is preferably made of surgical grade materials such as stainless steel. However, in the event the device is intended for a single use, materials such as plastics well known to the surgical arts may be readily used. 
     The first planar element  15  and second planar element  17  each has a top surface  23 , a bottom surface  25 , an inside edge  27 , an outside edge  29 , a front end  31 , a back end  33 , a length and a width. As used herein, in this context, the term “length” refers to the distance from the back end  33  to the front end  31  as denoted by line “aa”. This distance, from the front end  31  to the back end  33  corresponds to the distance between the front exterior of the oral cavity to an area of the tonsils. The area around the tonsils includes the area to the front of the tonsils and the area behind the tonsils. A surgeon may choose a device  11  in which the first planar element  15  and second planar element  17  are shorter or longer, extending in front of or behind the tonsils, depending on the surgeon&#39;s needs. 
     Each bottom surface  25  is for placing on the top of the tongue with the front end  31  into the oral cavity and the back end  33  toward the exterior of the oral cavity. Referring now to  FIG. 2 , the top surface  23  creates a chamber with the palate (not shown) of the patient for viewing and performing surgical procedures. 
     Referring now to  FIGS. 2 and 3 , each outside edge  29  of the first planar element  15  and the second planar element  17  is for positioning buccally, preferably, within the area of teeth. The inside edges  27  of the first planar element  15  and the second planar element  17  face each other, spaced apart a distance sized for at least one of the ventilation means selected by the surgeon on anesthesiologist. Well known ventilation means comprise laryngeal mask airway devices (not shown) and endotracheal tubes (not shown). Thus, the inside edges  27  are spaced in a range of approximately four to twenty-five millimeters, and, preferably, ten to twenty millimeters, to create a channel space. 
     Returning to  FIG. 1 , each bridge element  19  and  21  is affixed to the first planar element  15  and the second planar element  17  spanning the channel space. Turning to  FIG. 3 , each bridge element  19  and  21  is affixed to each top surface  23  of the first and second planar elements  15  and  17 . As depicted, each bridge element  19  and  21  is an arch extending toward the palate to allow ventilation means (not shown) to be retained between the tongue, the inside edges  27  of the first and second planar elements  15  and  17 , and each bridge element  19  and  21 . Thus, each bridge element  19  and  21  forms an arc of a partial, semi- or half circle, preferably with a diameter of about four to about twenty-five millimeters, and, more preferably, about ten to about twenty millimeters. This diameter corresponds generally to the dimensions of the ventilation means. 
     Each bridge element  19  and  21  has a length and a width. The length is dictated by the diameter of the arch and the width of the channel space between the inside edges  27  of the first planar element  15  and second planar element  17 . A preferred width is one to ten millimeters, and, more preferably, three to six millimeters. The bridge elements  19  and  21  are constructed and arranged to allow at least fifty percent and, more preferably, at least eighty percent, of the area of the channel space to be open. 
     The open channel space serves to allow the surgeon to view the ventilation means as well as to enlarge the viewable surgical field. During insertion and removal the surgeon may view the ventilation means to insure that the ventilation means is properly positioned. And, the surgeon can manually move or position the ventilation means to accommodate the needs of the surgical procedure. The two bridge elements  19  and  21  slide easily over the ventilation means. The device  11  is easily removed without unintentionally withdrawing the ventilation means. 
     Turning now to  FIGS. 1 and 2 , the first planar element  15  and the second planar element  17  have a straight portion  35  and a curved portion  37 . The curved portion  37 , shown with hatch-lines, is toward the front end  31  and corresponds to the curvature of the tongue moving downward into the larynx. The straight portion  35  is toward the back edge of each planar element. Preferably, the curved portion  37  creates an arc beginning its curve a distance in the range of approximately ten to twenty-five mm from the front end  31 . And, the front end is depressed a distance in the range of about five to about fifteen millimeters from a plane formed by the straight portion  35 . As used herein in the context of the straight portion  35 , the term “straight” is a relative term. The term encompasses a slight degree of curvature, which corresponds, with the shape of the end of tongue in the oral cavity. 
     Again referring to  FIGS. 1 and 2 , the device  11  has a handle  41  affixed to one or both of the first planar element  15  and the second planar element  17 . As depicted, the handle  41  extends from the back end  33  of both the first planar element  15  and second planar element  17  to allow the surgeon to firmly grasp the device  11  for the positioning in the oral cavity. 
     As best seen in  FIG. 1 , the handle  41  has an indent  45 , which may be preferred by some surgeons. Above the indent  45 , the surgeon can place the index finger and grip the handle  41  below the indent with the remaining fingers to improve his or her grip. The handle  41  extends at an angle from about 45 to about 135 degrees from the bottom surface  25  to place the handle away from the surgical field. Preferably, the handle rests on a surface placed on the patient&#39;s chest when the first planar element  15  and second planar element  17  are positioned against the tongue in the oral cavity. 
     Returning now to  FIGS. 1 and 2 , the device  11  has hanging means in the form of a hook  47  for hanging the device  11  on a surgical cart or table (not shown). The hook  47  extends from the handle  45  a distance to clear the patients chest when the device is in place but long enough to allow the hook  47  to rest and balance the device  11  as the device  11  is turned upside down with the flat surface  51  resting on the top of a surgical table with the device  11  suspended below. The end of the hook  47  may be flared to allow the hook to be received in a corresponding notch in the table or surgical cart, as best seen in  FIG. 2 . Other hanging means comprise hole  53  which allow the device  11  to be received in a pin (not shown), or the hook  47  may extend up toward the first planar surface  15  allowing the device  11  to be placed on a bar. 
     The present invention also provides a method for depressing the tongue using the device  11 . The method comprises the step of providing a device  11  having a first planar element  15 , second planar element  17  and at least one bridge element  19  and  21 . Gripping the handle  45 , the surgeon fits or places the bottom surface  25  on the top of the tongue with the front end  31  into the oral cavity and the back end  33  toward the exterior of the oral cavity. The top surface  23  creates a chamber with the palate of the patient for viewing and performing surgical procedures. The outside edge  29  of the first planar element  15  and the second planar element  17  are positioned buccally. 
     The inside edges  25  are spaced apart a distance sized for at least one of the ventilation means selected from the group of laryngeal mask airway devices and endotracheal tubes to create a channel space. The bridge elements  19  and  21  affixed to the first planar element  15  and the second planar element  17 , span the channel space. The bridging element allows at least about fifty percent of the area of the channel space to be open. 
     Upon completion of the operation or procedure, the device  11  is removed, sterilized and stored conveniently with the hook means  47  to be available to a surgeon for the next procedure. 
     Thus, the present invention has been described with respect to the preferred embodiment with the understanding that such embodiments can be altered and modified without departing from the teaching herein. Therefore, the present invention should not be limited to the precise details and description herein but should encompass the subject matter of the claims that follow and their equivalents.