Patent Publication Number: US-2022233832-A1

Title: Cryotherapy Systems and Methods

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application claims the benefit of priority to U.S. Provisional Pat. Appl. No. 62/861,591, filed on Jun. 14, 2019, the contents of which is hereby incorporated by reference in its entirety. The present applicant is also generally related to U.S. Pat. No. 9,687,288, filed Sep. 30, 2013, U.S. Pat. Publ. No. 2017/023147, filed Feb. 13, 2017, and U.S. Provisional Application No. 62/684,917, filed Jun. 14, 2018, the contents of which are hereby incorporated by reference in their entireties. 
    
    
     FIELD 
     The present disclosure is related to the field of therapeutic thermal interventions and, more particularly, to apparatuses and methods for hypothermic thermal treatments (e.g., cryotherapies including hypothermic cooling and cryoablation). 
     BACKGROUND 
     In general, thermal therapies involve treating tissue by inducing a temperature change that selectively induces alterations of the tissue, either temporarily or permanently. Depending on the tissue targeted for treatment, this thermal alteration may provide various benefits, including treatment of cardiac arrhythmia, destruction of cancerous tissue masses, and/or alteration of nerve signaling pathways. Ablation may be accomplished by applying heat (for example, with radiofrequency, laser, microwave, high intensity focused ultrasound (HIFU), or resistive heating methods) or by applying cooling energy (for example, using cryoablation techniques). 
     The term ‘cryotherapy’ describes a class of thermal therapies that involve inducing a relatively cold temperature in a tissue, and includes therapies generally referred to as therapeutic hypothermia and cryoablation. Depending on the temperatures and exposure times involved, the clinical goals of various cryotherapies may range from improved tissue healing/recovery (e.g., as with therapeutic hypothermia employed during physical therapy sessions) to selective tissue damage or destruction (e.g., during cryoablation used for neuromodulation or tumor-destruction purposes). Any tissue alteration introduced during cryotherapy may be temporary or permanent, depending on the tissue treated and one or more characteristics of the therapy applied to the tissue. 
     In practice, certain applications of cryotherapy may cause discomfort to a patient during and/or after treatment. For this reason, a medical practitioner may apply an anesthetic and/or an analgesic to the patient in tandem with the cryotherapy treatment. Indeed, medical practitioners generally endeavor to achieve adequate pain control when providing modern medical interventions. However, as some cryotherapies have moved away from operating room settings (where general anesthesia is available and practical) and into office-based settings (where only local anesthetics are generally available), existing pain control techniques for cryotherapy may be impractical or otherwise non-ideal for some procedures. Additionally, as medical practitioners have begun using cryotherapy interventions to target new anatomical regions, the potential physiological pathways and triggers for pain have also shifted, suggesting that improved solution pathways may emerge. Novel techniques, along with novel systems and apparatuses that enable these techniques, are required. 
     Rhinitis is defined as inflammation of the membranes lining the nose, and is characterized by nasal symptoms including itching, rhinorrhea, and/or nasal congestion. Chronic rhinitis affects millions of people and is a leading cause for patients to seek medical care. Medical treatment has been shown to have limited effects for chronic rhinitis sufferers and requires daily medication use or onerous allergy treatments, and up to 20% of patients may be refractory. Selectively interrupting the Posterior Nasal Nerves (PNN), Accessory Posterior Nasal Nerves (APNN), and/or other nervous structures in patients with chronic rhinitis (e.g., by applying cryotherapy within the nasal cavity to cryoablate these nerves) has been shown to improve symptoms with limited to elimination of side effects. 
     There are a number of possible physiological pathways by which the application of cryotherapy within the nasal cavity may lead to discomfort, either during the treatment or in the period following treatment. The mucosal and submucosal regions of the nasal cavity contain numerous sensory nerve fibers which primarily originate from the first and second branches (V1 and V2) of the trigeminal nerve (the fifth cranial nerve). Activation of these sensory nerves by cold stimuli may lead to sensations of pain. Pain may also be induced via an indirect activation of nerve endings, which may be possible via reflex arcs similar to the trigeminal-autonomic reflex (often associated with migraine, cluster headache, and other syndromes), and/or due to processes such as trigeminal sensitization, which may result in cold stimuli in the nose leading to discomfort felt in the anterior forehead, teeth/jaw, or in other regions. Additionally, the activation of reflex arcs leading to cold-stimulus headache (i.e. “ice-cream headache”) is possible in some scenarios, as the cooling of blood flowing through the treatment region, the cooling of nasally-inhaled air, and other mechanisms may all trigger significant cooling of regions that include the soft palate and the posterior pharyngeal wall. An ideal pain management solution would control for all pathways of possible discomfort associated with a particular intervention in order to ensure that a patient has a positive experience. In practice, solutions are needed that balance practicality, patient tolerance, and effectiveness. 
     The response of sensory afferent nerves to cold stimuli is complex. Within the nasal cavity, it is generally believed that there are at least two types of nerve fibers responsive to cold noxious stimuli (these fibers are oftentimes called ‘thermoreceptors’): (i) A-delta fibers, which are thick and myelinated, and (ii) C fibers, which are thin and unmyelinated. According to a scholarly publication by Wasner and colleagues (Wasner et al, Topical menthol—a human model for cold pain by activation and sensitization of C nociceptors,  Brain  127:1159-1171, 2004—incorporated herein by reference), A-delta fibers are thought to carry painless cold sensations, whereas C fibers are thought to conduct pain. Again, according to Wasner and colleagues, studies suggest that cold-specific A-delta fibers may suppress the sensation of pain originating from C fibers, and accordingly the selective inhibition of A-delta fibers may amplify cold-induced pain. However, A-delta fibers are generally more sensitive than C fibers to topical anesthetics typically utilized in nasal procedures, such as lidocaine, tetracaine, and bupivacaine. As such, there may be a risk of inadequate anesthesia failing to inhibit pain-producing C fibers while at the same time exacerbating the situation by successfully inhibiting the A-delta fibers that help suppress these pain sensations. Accordingly, the most suitable approaches to anesthesia for cryotherapy applied within the nasal cavity will consider this complex response. Novel methods and enabling-devices would benefit this endeavor and improve care for patients 
     SUMMARY 
     The present disclosure is related to systems, devices, and methods for applying anesthesia for thermal therapies. More specifically, the present disclosure relates to applying local anesthesia for hypothermic treatments of body tissues. This disclosure is particularly useful when treating patients during office-based procedures, or in other situations where general anesthesia is not available, practical, and/or advisable. The disclosure can be particularly useful during cryotherapy procedures applied within the upper airway. 
     It is an objective of the present disclosure to provide methods, devices, and systems that advance the delivery of local anesthetics with solutions that improve the balance between simplicity, practicality, and effectiveness. More specifically, it is an objective of the present disclosure to allow for adequate anesthesia for cryotherapies in the nasal cavity or other body lumens. Accomplishing this objective is valuable because it will improve the patient experience when receiving these valuable treatments which may encourage more patients to elect to receive said treatments. 
     In an example, an apparatus for delivering an anesthetic agent to a target tissue in a nasal cavity of a patient is described. The apparatus includes an elongated shaft and an applicator coupled to a distal end of the elongated shaft. The applicator includes a cryotherapy delivery feature configured to use a cryogen to apply thermal energy to the target tissue. The apparatus also includes one or more protrusions coupled to the applicator. Each protrusion includes a tip that is configured to penetrate the target tissue. Each protrusion is configured to actuated from a retracted state to an extended state. For each protrusion, (i) in the retracted state, the tip of the protrusion is at a first distance from an exterior surface of the applicator, (ii) in the extended state, the tip of the protrusion is at a second distance from the exterior surface of the applicator, and (iii) the second distance is greater than the first distance. The apparatus further includes one or more lumens extending through the elongated shaft. The one or more lumens are configured to transmit an anesthetic agent from an anesthetic agent to the one or more protrusions. Each protrusion includes an exit port that is configured to deliver the anesthetic agent to the target tissue in the nasal cavity. 
     In another example, an apparatus for delivering an anesthetic agent to a target tissue in a nasal cavity of a patient is described. The apparatus includes an elongated shaft and an applicator coupled to a distal end of the elongated shaft. The applicator includes a cryotherapy delivery feature configured to use a cryogen to apply thermal energy to the target tissue. The apparatus also includes a needle having a tip that is configured to penetrate the target tissue. The needle is actuatable between from a retracted state and an extended state. In the retracted state, the tip of the needle is at a first distance from the applicator. In the extended state, the tip of the needle is at a second distance from the applicator. The second distance is greater than the first distance. The apparatus further includes a needle guide system configured to facilitate translating the needle between the retracted state and the extended state. 
     In another example, a method for delivering an anesthetic agent to a target tissue in a nasal cavity of a patient is described. The method includes inserting a cryotherapy device into the nasal cavity of the patient. The cryotherapy device includes a cryotherapy delivery feature and one or more protrusions. The method also includes positioning the cryotherapy delivery feature in contact with the target tissue, and delivering, using the cryotherapy delivery feature, a cryotherapy treatment to the target tissue. After inserting the cryotherapy device into the nasal cavity, the method includes actuating the one or more protrusions from a retracted state to an extended state. After actuating the one or more protrusions to the extended state, the method includes penetrating the target tissue with the one or more protrusions. After penetrating the target tissue, the method includes delivering, via the one or more protrusions, an anesthetic agent into the target tissue. 
     The features, functions, and advantages that have been discussed can be achieved independently in various examples or may be combined in yet other examples further details of which can be seen with reference to the following description and drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
       The novel features believed characteristic of the illustrative examples are set forth in the appended claims. The illustrative examples, however, as well as a preferred mode of use, further objectives and descriptions thereof, will best be understood by reference to the following detailed description of an illustrative example of the present disclosure when read in conjunction with the accompanying drawings, wherein: 
         FIG. 1  illustrates a simplified block diagram of a cryotherapy device, according to an example. 
         FIG. 2A  illustrates a first side of a distal portion of the cryotherapy device of  FIG. 1  positioned proximate to a target tissue, according to an example. 
         FIG. 2B  illustrates a second side of the cryotherapy device of  FIG. 2A , according to an example. 
         FIG. 3  illustrates a distal portion of the cryotherapy device of  FIG. 1 , according to another example. 
         FIG. 4A  illustrates a distal portion of the cryotherapy device of  FIG. 1  with a sheath in a distal position, according to another example. 
         FIG. 4B  illustrates the cryotherapy device of  FIG. 4A  with the sheath in a proximal position, according to an example. 
         FIG. 5A  illustrates a distal portion of the cryotherapy device of  FIG. 1  in a covered state, according to another example. 
         FIG. 5B  illustrates the cryotherapy device of  FIG. 5A  in a partially exposed state, according to an example. 
         FIG. 5C  illustrates the cryotherapy device of  FIG. 5A  in a fully exposed state, according to an example. 
         FIG. 6  illustrates a distal portion of the cryotherapy device of  FIG. 1 , according to another example. 
         FIG. 7  illustrates a protrusion for delivering an anesthetic agent, according to an example. 
         FIG. 8  illustrates a distal portion of the cryotherapy device of  FIG. 1 , according to another example. 
         FIG. 9A  illustrates a distal portion of the cryotherapy device of  FIG. 1  with a needle in a retracted state, according to another example. 
         FIG. 9B  illustrates the distal portion of the cryotherapy device of  FIG. 9A  with the needle in an extended state, according to an example. 
         FIG. 9C  illustrates a cross-sectional view of the cryotherapy device of  FIG. 9A , according to an example. 
         FIG. 10  illustrates a distal portion of the cryotherapy device of  FIG. 1 , according to another example. 
         FIG. 11A  illustrates a distal portion of the cryotherapy device of  FIG. 1  with a needle in a retracted state, according to another example. 
         FIG. 11B  illustrates a cross-sectional view of the cryotherapy device of  FIG. 11A , according to an example. 
         FIG. 11C  illustrates the distal portion of the cryotherapy device of  FIG. 11A  with the needle in an extended state, according to an example. 
         FIG. 12  illustrates a flowchart for a method of using a cryotherapy device, according to an example. 
         FIG. 13  illustrates a flowchart for a method of using a cryotherapy device that can be used with the method shown in  FIG. 12 , according to an example. 
         FIG. 14  illustrates a flowchart for a method of using a cryotherapy device that can be used with the method shown in  FIG. 13 , according to an example. 
     
    
    
     DETAILED DESCRIPTION 
     Disclosed examples will now be described more fully hereinafter with reference to the accompanying drawings, in which some, but not all of the disclosed examples are shown. Indeed, several different examples may be described and should not be construed as limited to the examples set forth herein. Rather, these examples are described so that this disclosure will be thorough and complete and will fully convey the scope of the disclosure to those skilled in the art. 
     The present disclosure is related to systems, devices, and methods for applying comfort control for thermal therapies. More specifically, the present disclosure relates to applying comfort control for hypothermic treatments of body tissues. The systems, devices, and methods of the present disclosure can be particularly useful when delivering thermal-based or other non-thermal treatments to patients in an office-based setting. Use of the disclosed methods, devices, and systems can improve management of pain during and/or following medical treatments. 
     Various aspects of the disclosure described herein may be applied to any of the particular applications set forth below or for any other types of thermal or non-thermal treatment systems or methods. The disclosure may be applied as a standalone system or method, or as part of an integrated medical treatment system. 
     Referring now to  FIG. 1 , a simplified block diagram of a cryotherapy device  100  is shown according to an example. As shown in  FIG. 1 , the cryotherapy device  100  includes an elongated shaft  110  that extends between a proximal portion  112  of the cryotherapy device  100  and a distal portion  114  of the cryotherapy device  100 . The elongated shaft  110  can be configured to be at least partially inserted in a nasal cavity of a patient. For example, the elongated shaft  110  can have a diameter between approximately 1 mm and approximately 4 mm. Additionally, for example, the elongated shaft  110  can be made from stainless Steel and/or semi-rigid polymer (e.g., such as Nylon or Pebax). The elongated shaft  110  can also be made of a combination of these. 
     Although the elongated shaft  110  is shown as being separate from the proximal portion  112  and the distal portion  114  in  FIG. 1 , the proximal portion  112  and/or the distal portion  114  of the cryotherapy device  100  can include respective portions of the elongated shaft  110 . More generally, the proximal portion  112  can include one or more components of the cryotherapy device  100  that are located relatively farther away from a target tissue to be treated with cryotherapy during a cryotherapy procedure, and the distal portion  114  can include one or more components of the cryotherapy device  100  that are located relatively closer to the target tissue during the cryotherapy procedure. As used herein, the term “target tissue” means a tissue that is to be treated with cryotherapy during the cryotherapy procedure. 
     The proximal portion  112  can include a handpiece  116 , one or more user control devices  118  (e.g., one or more knobs, one or more triggers, one-or more buttons, one or more switches, one or more levers, and/or one or more dials), a cryogen source  120  (e.g., a compressed gas canister and/or a fluid reservoir), and/or other features. 
     Within examples, the handpiece  116  can be configured to facilitate gripping and manipulating the cryotherapy device  100 . For instance, the handpiece  116  can have a shape and/or a size that can facilitate a user performing a cryotherapy operation by manipulating the elongated shaft  110  and the distal portion  114  using a single hand. In one example, the handpiece  116  can have a shape and/or a size that facilitates the user holding the handpiece  116  in a pistol gripping manner (e.g., the handpiece  116  can have an axis that is transverse to an axis of the elongated shaft  110 ). In another example, the handpiece  116  can additionally or alternatively have a shape and/or a size that facilitates the user holding the handpiece  116  in a writing utensil gripping manner (e.g., the handpiece  116  can have an axis that is substantially parallel to an axis of the elongated shaft  110 ). Additionally or alternatively, the handpiece  116  can facilitate gripping and manipulating the cryotherapy device  100  by having a shape and/or a size that is greater than a shape and/or a size of the elongated shaft  110 . 
     The cryogen source  120  can store a cryogen  122  such as, for example, nitrous oxide, liquid carbon dioxide, and/or liquid chlorofluorocarbon. In some implementations, the cryogen source  120  can be located in the handpiece  116 . This can beneficially provide for a relatively compact size of the cryotherapy device  100  by, for example, reducing or eliminating relatively long external connections (e.g., tubes and/or cables) between the handpiece  116  and the cryogen source  120 . In other implementations, the cryogen source  120  can be in a housing that is separate from the handpiece  116 . This can beneficially allow the cryogen source  120  to store a relatively larger amount of the cryogen  122  without impairing the handling capabilities of the handpiece  116 . 
     As shown in  FIG. 1 , the elongated shaft  110  can include one or more lumens  124 . The lumen(s)  124  can include a first end that is coupled to the cryogen source  120  and a second end that is coupled to a applicator  126  at the distal portion  114  of the cryotherapy device  100 . In this arrangement, the lumen(s)  124  can couple the cryogen source  120  and the applicator  126 . 
     Within examples, the user control device(s)  118  can control a flow of the cryogen  122  from the cryogen source  120  to the applicator  126 . For instance, the user control device(s)  118  can include one or more knobs, one or more triggers, one-or more buttons, one or more switches, one or more levers, and/or one or more dials that can be actuated to start, stop, increase, and/or decrease a flow of the cryogen  122  from the cryogen source  120  to the applicator  126 . Also, within examples, the user control device(s)  118  can be located on the handpiece  116  and/or at a location that is separate from the handpiece  116 . 
     As described above, the distal portion  114  includes the applicator  126 . The applicator  126  includes a cryotherapy delivery feature  128 . In general, the cryotherapy delivery feature  128  is configured to use the cryogen  122  to apply thermal energy to the target tissue. As such, the cryotherapy delivery feature  128  is coupled to the cryogen source  120  via the lumen(s)  124 ). In one example, the cryotherapy delivery feature  128  can include a balloon into which the cryogen  122  (e.g., in the form of a compressed liquid) can expand as a gas. As another example, the cryotherapy delivery feature  128  can include a metallic plate, which can be chilled through contact with the cryogen  122  (e.g., in the form of a circulating cooled fluid). In these examples, the cryotherapy delivery feature  128  includes an intermediary feature (e.g., the balloon and/or the metallic plate) that transfers the thermal energy from the cryogen  122  to the target tissue. This can beneficially help to improve the uniformity of the distribution of cold temperatures applied across a targeted region of tissue. This indirect application of cooling can also prevent cryogen substances (e.g. saline, or other liquids or gases) from direct exposure to the body in unwanted regions. For example, cold saline applied directly to the nasal cavity would run down a patient&#39;s throat, causing discomfort and possible tissue injury in unwanted regions. 
     In some implementations, the cryotherapy delivery feature  128  can have an active surface that is configured for contacting the target tissue such that relatively little or no thermal energy is applied to tissue regions remote from the active surface. For example, the cryotherapy delivery feature  128  can include the active surface and an inactive surface such that the cryotherapy delivery feature  128  applies the thermal energy to the target tissue contacting the active surface and does not apply the thermal energy to other tissue contacting the inactive surface. This can help to apply thermal energy in a relatively targeted manner to treat a specific target tissue. 
     In other implementations, an entirety of the cryotherapy delivery feature  128  can be active such that the cryotherapy delivery feature  128  applies the thermal energy omni-directionally. This can help to apply the thermal energy more broadly and, in some instances, can help to reduce a time for performing a cryotherapy procedure. 
     Accordingly, in this arrangement, the cryotherapy device  100  can be used to perform a cryotherapy procedure on the target tissue in the nasal cavity. For example, in operation, the cryotherapy device  100  can be inserted in the nasal cavity to position the applicator  126  at the target tissue (e.g., with the active surface(s) of the cryotherapy delivery feature  128  contacting the target tissue). After the applicator  126  is positioned at the target tissue, the user control device(s)  118  can be operated to cause the cryogen source  120  to supply the cryogen  122  to the cryotherapy delivery feature  128  via the lumen(s)  124  extending through the elongated shaft  110 . The cryotherapy delivery feature  128  of the applicator  126  can use the cryogen  122  to apply the thermal energy to the target tissue to alter the target tissue and treat one or more conditions. 
     Within examples, the cryotherapy device  100  can additionally apply an anesthetic agent to the target tissue before, during, or after applying the thermal energy to the target tissue. For instance, as shown in  FIG. 1 , the cryotherapy device  100  can further include an anesthetic agent source  130  at the proximal portion  112 . The anesthetic agent source  130  can store an anesthetic agent  132 . As examples, the anesthetic agent  132  can include formulations of lidocaine, marcaine, tetracaine, bupivacaine, cocaine, and/or other anesthetic agents commonly utilized during medical procedures. 
     The anesthetic agent source  130  is coupled to the applicator  126  via the lumen(s)  124  extending through the elongated shaft  110 . The applicator  126  can include an anesthetic agent delivery feature  134  that is configured to deliver the anesthetic agent  132  to the target tissue. For example, the anesthetic agent delivery feature  134  can include one or more protrusions and/or one or more needles that are configured to pierce and penetrate the target tissue. Additionally, for example, the protrusion(s) and/or the needle(s) can include one or more ports that provide for egress of the anesthetic agent  132  from the applicator  126  to the target tissue. 
     In some examples, the anesthetic agent source  130  can be separate from the handpiece  116 . For instance, in one implementation, the anesthetic agent source  130  can include a syringe that contains the anesthetic agent  132 . In this implementation, the syringe can be coupled to an infusion port on the handpiece  116  and a plunger of the syringe can be actuated to supply the anesthetic agent  132  from the anesthetic agent source  130  to the anesthetic agent delivery feature  134  (e.g., via the lumen(s)  124 ) and from the anesthetic agent delivery feature  134  to the target tissue. Thus, in this implementation, the anesthetic agent source  130  can provide a fluid pressure for delivering the anesthetic agent  132  through the lumen(s)  124  and out the anesthetic agent delivery feature  134  to the target tissue. 
     In other examples, the anesthetic agent source  130  can be integrated with the handpiece  116  and/or actuated by the user control device(s)  118 . For instance, in one implementation, the anesthetic agent source  130  can be a disposable reservoir or a resusable reservoir that housed in the handpiece  116 . The anesthetic agent source  130  can also include one or more valves and/or one or more pumps that facilitate supplying the anesthetic agent  132  from the anesthetic agent source  130  to the anesthetic agent delivery feature  134  of the applicator  126 . The valve(s) and/or the pump(s) can be operable by the user control device(s)  118  to start, stop, increase, and/or decrease a flow of the anesthetic agent  132  from the anesthetic agent source  130  to the anesthetic agent delivery feature  134  of the applicator  126 . 
     Accordingly, in the arrangement shown in  FIG. 1 , the cryotherapy device  100  can apply a combination of cryotherapy and anesthesia to treat the target tissue. As described above, applying local anesthesia using the anesthetic agent  132  before, during, and/or after applying the thermal energy of the cryotherapy procedure can beneficially help to improve patient comfort and/or increase access to types of cryotherapy procedures in office-based settings, which may not have been previously available due to a lack of general anesthesia capabilities in such office-based settings. 
       FIGS. 2A-11C  show a plurality of distal portions that can be implemented in connection with the cryotherapy device  100  shown in  FIG. 1 , according to examples of the present disclosure. In particular,  FIGS. 2A-11C  show various example implementations for the elongated shaft  110 , the applicator  126 , the cryotherapy delivery feature  128 , and/or the anesthetic agent delivery feature  134  shown in  FIG. 1 . The examples shown in  FIGS. 2A-11C  will now be described. 
     Referring now to  FIGS. 2A-2B , a distal portion  214  of a cryotherapy device  200  is shown according to an example. The cryotherapy device  200  is substantially similar or identical to the cryotherapy device  100  shown in  FIG. 1 . As shown in  FIGS. 2A-2B , the cryotherapy device  200  includes an applicator  226  coupled to a distal end  236  of an elongated shaft  210 . As described above, the elongated shaft  210  can include the one or more lumens (e.g., the lumen(s)  124 ) that fluidly couple the applicator  226  to a cryogen source (e.g., the cryogen source  120 ). 
     In  FIG. 2A , the applicator  226  is positioned proximate to a target tissue  238  that is to be treated during a cryotherapy procedure using the cryotherapy device  200 . The applicator  226  includes a first side  240 , which is positioned facing and in contact with the target tissue  238 . As explained in further detail below, the first side  240  can include an active surface and thus provide a treatment side for applying cryotherapy to the target tissue  238 . The applicator  226  can also include a second side  242 , which is opposite the first side  240 . Within examples, the second side  242  can be an active surface or an inactive surface.  FIG. 2A  shows the second side  242  and  FIG. 2B  shows the first side  240 . 
     As shown in  FIG. 2B , the applicator  226  includes a containable expandable member  244  in communication with the cryogen source via the lumen(s). Within examples, the expandable member  244  can be actuated between a collapsed state and an expanded state. The expandable member  244  can be actuated from the collapsed state to the expanded state by supplying the cryogen from the cryogen source to the expandable member  244  (e.g., via the lumen(s)  124 ). Specifically, when the cryogen source is operated (e.g., via the user control device(s)  118 ) to supply the cryogen to the expandable member  244 , the expandable member  244  can fill with the cryogen (e.g., a gas from an evaporating liquid cryogen such as nitrous oxide) and expand the expandable member  244  from the collapsed state to the expanded state. In an example, the expandable member  244  can be actuated from the expanded state to the collapsed state by operating the user control device(s)  118 ) to cause the cryogen source to cease supplying the cryogen to the expandable member  244 . 
     The expandable member  244  can be configured to transfer thermal energy from the cryogen to the target tissue  238 . As such, the cryotherapy delivery feature  128  described above can include the expandable member  244  in the example shown in  FIGS. 2A-2B . 
     In the collapsed state, the expandable member  244  can have a first size and/or a first shape. In the expanded state, the expandable member  244  can have a second size and/or a second shape. The first size and/or the first shape of the expandable member  244  in the collapsed state can facilitate inserting the expandable member  244  to through the nasal cavity to the target tissue. Whereas, the second size and/or the second shape of the expandable member  244  can help to engage the expandable member  244  with the target tissue and/or retain the expandable member  244  in a relatively fixed position at the target tissue. Accordingly, within examples, the first size can be less than the second size. In some examples, the first shape can be the same as the second shape. In other examples, the first shape can be different than the second shape. In some implementations the second shape can be based, at least in part, on a type of tissue that the expandable member  244  is configured to engage at the target tissue. 
     As shown in  FIG. 2B , the applicator  226  can also include a scaffolding  246 , which can provide structural rigidity to support the expandable member  244  (e.g., the scaffolding  246  can have a stiffness that is greater than a stiffness of the expandable member  244 ). Increasing or enhancing the structural rigidity of the applicator  226  to support the expandable member  244  can assist in manipulating a position of the applicator  226  with relatively greater precision and control than may be achieved if the expandable member  244  omitted the scaffolding  246 . This can be particularly beneficial when manipulating the position of the applicator  226  when the expandable member  244  is in the collapsed state (e.g., during insertion of the applicator  226  to the target tissue). 
     In  FIG. 2B , the scaffolding  246  extends along a longitudinal axis between a proximal end  240 A of the expandable member  244  and a distal end  240 B of the expandable member  244 . This can assist with structural support of the expandable member and also provide mechanical strength to the distal portion of the cryotherapy device  200  to enhance maneuverability of the cryotherapy device  200  within the nasal cavity. However, in another example, the scaffolding  246  can additionally or alternatively extend in one or more directions that are transverse to the longitudinal axis. This can assist with further structural support of the expandable member  244 , which may limit unwanted folding of the expandable member  244  that could occur as it makes contact with tissues during navigation to the desired treatment location. 
     Also, in  FIG. 2B , the scaffolding  246  can be located in an internal cavity of the expandable member  244 . This can help with maintaining a soft atraumatic surface for the distal portion of the cryotherapy device  200  and also, in some examples, allow for the scaffolding  246  to help deliver the cryogen centrally into the expandable member  244 . However, in other examples, the scaffolding  246  can be located on an exterior surface of the expandable member  244 . This can help to assemble the cryotherapy device  200  during a manufacturing process. 
     As examples, the expandable member  244  can be made from one or more materials including latex, silicone, urethane, and/or nylon. Also, as examples, the scaffolding  246  can be made from one or more materials including stainless steel, nitinol, and/or copper. Within examples, the scaffolding  246  has a stiffness that is greater than the expandable member  244 . 
     As shown in  FIG. 2B , the applicator  226  also includes a plurality of protrusions  248 , which can extend from the scaffolding  246  near a central portion  250  of the applicator  226 . In general, the protrusions  248  may be configured to allow for one or more fluids, one or more gases, and/or other materials to travel along one or more internal lumens  252  of the protrusions  248 . For instance, as examples, the protrusions  248  can include a plurality of needles, cannulas, or other conduits through which the fluid(s), the gas(es), and/or the other material(s) can flow. 
     The protrusions  248  can also be configured to penetrate a soft tissue at or proximate to an implantation site (i.e., the target tissue  238 ). For instance, the protrusions  248  can be constructed from a material having a column strength that allows the protrusions  248  to penetrate the target tissue  238  without buckling or otherwise becoming kinked or bent. As examples, the protrusions  248  can be made from stainless steel and/or nitinol. Also, for instance, the protrusions  248  can have a beveled end that tapers to a point (i.e., similar to the tip of a needle) to facilitate penetrating the soft tissue and/or one or more frozen regions of the soft tissue (e.g., in instances in which the protrusions  248  are applied to the target tissue  238  after applying cryotherapy to the target tissue  238 ). As examples, to facilitate penetrating the soft tissue, the protrusions  248  can extend approximately 1 millimeter (mm) to approximately 4 mm from an exterior surface of the applicator  226 . 
     Also, within examples, the protrusions  248  can include one or more exit ports  254  such that the protrusions  248  can deliver the fluid(s), the gas(es), and/or the other material(s) into the target tissue  238 , which the protrusions  248  penetrate, or into other nearby tissues (e.g., tissues that are not penetrated and which may not be contiguous with the penetrated tissues). In some examples, for each protrusion  248 , the exit port(s)  254  can be located at a tip  256  of the protrusion  248 . In other examples, for each protrusion  248 , the exit port(s)  254  can be additionally or alternatively located along a body of the protrusion  248  at one or more positions between the exterior surface of the applicator  226  and the tip  256  of the protrusion  248 . In one example, when a protrusion penetrates a tissue, a portion of the exit ports  254  can be located in the penetrated tissue, whereas another portion of the exit ports  254  can be outside of the penetrated tissue such that the anesthetic agent can drip onto other nearby tissues 
     In some examples, the protrusions  248  can be actuated from a retracted state to an extended state. In the retracted state, the tips of the protrusions  248  can be positioned adjacent to the exterior surface of the applicator  226  or recessed in a body of the applicator  226  (i.e., at a position inward of the exterior surface). This can assist in providing the applicator  226  with a relatively low profile shape and/or size, which can help to mitigate (or prevent) unwanted tissue damage and/or discomfort while inserting the applicator  226  to the target tissue  238 . 
     In the extended state, the tips  256  of the protrusions  248  can project outwardly from the exterior surface of the applicator  226 . This can facilitate the protrusions  248  penetrating the target tissue  238 . Within examples, (i) the tips  256  of the protrusions  248  can be at a first distance from the exterior surface of the applicator  226  when the protrusions  248  are in the retracted state, (ii) the tips  256  of the protrusions  248  can be at a second distance from the exterior surface of the applicator  226  when the protrusions  248  are in the retracted state, and (iii) the second distance can be greater than the first distance. 
     In one implementation, the protrusions  248  can be initially retracted within a body of the applicator  226  when the protrusions  248  are in the retracted state, and the protrusions  248  can then be deployed by a user (e.g., by operating the user control device(s)  118  of the proximal portion  112  of the cryotherapy device  100 ) to project outwardly when the protrusions  248  are in the extended state. In some implementations, the protrusions  248  can project outwardly from the body of the applicator  226  (e.g., via a spring-based mechanism that is released by manipulating user control device(s)  118 ) with a force that is sufficient to penetrate the target tissue  238 . For instance, actuating the protrusions  248  from the retracted state to the extended state can include piercing and penetrating the target tissue  238  in some examples. 
     In another implementation, in the retracted state, the protrusions  248  can be initially folded against the exterior surface such that the first side  240  (i.e., the treatment side) of the applicator  226  is substantially flat. In this implementation, the protrusions  248  can actuate from the retracted state to the extended state by rotating (e.g., via a hinge or a joint) outward away from the exterior surface of the applicator  226 . 
     Within examples, the user control device(s)  118  shown in  FIG. 1  can be operable to actuate the protrusions  248  between the retracted state and the extended state. As examples, the user control device(s)  118  can include one or more knobs, dials, toggles, buttons, and/or other features that control the mechanical relays (e.g. pulleys, springs, etc.) for deploying and retracting the protrusions  248  between the retracted state and the extended state. 
     In  FIG. 2B , the protrusions  248  extend from the scaffolding  246  and the central portion  250  of the applicator  226 . This can help to effectively deliver an anesthetic agent to the center portion of the treated area while minimizing the number of protrusions and tissue penetration sites. 
     However, in other examples, the protrusions  248  can extend from other portions of the applicator  226 .  FIG. 3  shows a distal portion  314  of a cryotherapy device  300  according to another example. As shown in  FIG. 3 , the cryotherapy device  300  includes an applicator  326  coupled to an elongated shaft  310  and having an expandable member  344 , as described above. The cryotherapy device  300  is substantially similar or identical to the cryotherapy devices  100 ,  200  described above, except the cryotherapy device  300  includes an applicator  326  having a plurality of protrusions  348  in an alternative arrangement. Specifically, in  FIG. 3 , the protrusions  348  extend from a peripheral portion  358  of the applicator  326 , which extends around a central portion  350  of the applicator  326 . Positioning the protrusions  348  at and/or around the peripheral portion  358  can help achieve broader delivery of an anesthetic agent, and therefore more complete coverage of a tissue region. 
     Although the protrusions  248  extend from the central portion  250  of the applicator  226  in  FIG. 2  and the protrusions  348  extend from the peripheral portion  358  in  FIG. 3 , the protrusions  248 ,  348  can extend from the central portion  250  and the peripheral portion  358  in other examples. 
     Referring now to  FIGS. 4A-4B , a distal portion  414  of a cryotherapy device  400  is shown according to another example. As shown in  FIGS. 4A-4B , the cryotherapy device  400  includes an applicator  426  coupled to an elongated shaft  410 , as described above. The cryotherapy device  400  also includes a sheath  460  that is translatable along the elongated shaft  410  between (i) a distal position on the elongated shaft  410  shown in  FIG. 4A  and (ii) a proximal position on the elongated shaft  410  shown in  FIG. 4B . In the distal position shown in  FIG. 4A , the sheath  460  covers (or at least partially covers) the applicator  426  (i.e., the cryotherapy device  400  is in a covered state). Whereas, in the proximal position shown in  FIG. 4B , the sheath  460  exposes the applicator  426  (i.e., the cryotherapy device  400  is in an exposed state). 
     As shown in  FIG. 4B , the applicator  426  can include a plurality of protrusions  448  configured to deliver an anesthetic agent (e.g., the anesthetic agent  132 ) as described above. Within examples, the sheath  460  can actuate the protrusions  448  between the retracted state and the extended state described above. For instance, when the sheath  460  is in the distal position shown in  FIG. 4A , the sheath  460  can apply a force that moves the protrusions  448  from an extended position (shown in  FIG. 4B ) to a retracted position in which the protrusions  448  are flattened against the applicator  426  and/or the protrusions  448  are recessed in the applicator  426 . This can allow the applicator  426  to have a relatively slim and atraumatic profile, which can help facilitate inserting the applicator  426  in a nasal cavity to a target tissue (e.g., the target tissue  238  in  FIG. 2 ). 
     Within examples, to actuate and/or maintain the protrusions  448  in the retracted state, the sheath  460  can circumferentially surround at least a portion of the applicator  426  adjacent to the protrusions  448 . In some implementations, the sheath  460  can extend around an entire circumference of the applicator  426 . 
     As described above, when the sheath  460  is in the proximal position exposing the applicator  426 , the protrusions  448  extend outwardly from the applicator  426  toward the target tissue. Thus, when the sheath  460  is in the proximal position, the protrusions  448  can penetrate the target tissue and deliver the anesthetic agent to the target tissue. Within examples, after delivering the anesthetic agent to the target tissue, the sheath  460  can be actuated from the proximal position to the distal position to re-cover the applicator  426  and actuate the protrusions  448  from the extended state to the retracted state. Thus, positioning the sheath  460  in the distal position covering the protrusions  448  and the applicator  426  can additionally or alternatively facilitate withdrawing the applicator  426  out of the nasal cavity after completion of a procedure. 
     As examples, the sheath  460  can be comprised of a relatively soft and a relatively flexible material such as, for instance, nylon and/or another woven polymer. In other examples, the sheath  460  can be additionally or alternatively comprised of polytetrafluoroethylene (PTFE), a metallic braid, a metallic coiled ribbon, Polyimide, fluorinated ethylene propylene (FEP), and/or PEBAX. 
     In some examples, the sheath  460  can be similar to a hypotube adapted to slide along the elongated shaft  410  of the cryotherapy device  400 . In some implementations, the cryotherapy device  400  can include a mechanical adjustment system that is operable by one or more user control devices (e.g., the user control device(s)  118  in  FIG. 1 ) to adjust a position of the sheath  460  on the elongated shaft  410 . For instance, in one implementation, a position of the sheath  460  can be adjusted by a user operating the one or more user control device(s) (e.g., such as a dial or toggle on the handpiece  116 ) that are in mechanical communication with a pulley or other mechanical system coupled to the sheath  460 . In other implementations, the position of the sheath  460  can be adjusted directly by the user grabbing and moving the sheath  460  proximally and/or distally along the elongated shaft  410 . Other examples are also possible. 
     Referring now to  FIGS. 5A-5C , a cryotherapy device  500  is shown according to another example. The cryotherapy device  500  is substantially similar or identical to the cryotherapy device  400  described above with respect to  FIGS. 4A-4B , except the cryotherapy device  500  includes an applicator  526  that is configured differently than the applicator  426  shown in  FIGS. 4A-4B . 
       FIG. 5A  shows the cryotherapy device  500  in a covered state,  FIG. 5B  shows the cryotherapy device  500  in a partially exposed state, and  FIG. 5C  shows the cryotherapy device  500  in a fully exposed state. As shown in  FIGS. 5A-5C , the cryotherapy device  500  includes the applicator  526  coupled to an elongated shaft  510 , as described above. The cryotherapy device  500  further includes a sheath  560  that is translatable between (i) a distal position on the elongated shaft  510  shown in  FIG. 5A , and (ii) a proximal position on the elongated shaft  510  shown in  FIG. 5C . As described above, when the sheath  560  is in the distal position, the sheath  560  covers the applicator  526  and maintains a plurality of protrusions  548  in a retracted state. When the sheath  560  is in the proximal position, the sheath  560  exposes the applicator  526  and the protrusions  548  extend outwardly from the applicator  526  in an extended state. 
     In  FIGS. 5A-5C , the applicator  526  includes a plurality of arms  562  extending from a central portion  550  of the applicator  526 . In this example, the arms  562  include the protrusions  548 . One or more of the arms  562  are movable about the central portion  550  such that the arms  562  can be collapsed to a position substantially aligned with a longitudinal axis of the sheath  560  and expanded to respective positions that diverge from the longitudinal axis of the sheath  560  (e.g., the arms  562  can fan out and/or spread out from each other). As an example, the arms  562  can be coupled to the central portion  550  by one or more hinges (e.g., one or more living hinges) and/or another pivoting structure. 
     In  FIG. 5A , when the sheath  560  covers the applicator  526 , the sheath  560  can cover the arms  562  and thereby position the arms  562  in the positions substantially aligned with the longitudinal axis of the sheath  560 . As shown in  FIG. 5B , as the sheath  560  moves from the distal position shown in  FIG. 5A  toward the proximal position shown in  FIG. 5C , the sheath  560  initially exposes a portion of the applicator  526 . This causes the arms  562  of the applicator  526  to begin spreading out from the central portion  550  (e.g., fan out and/or move radially away from each other). As shown in  FIG. 5C , when the sheath  560  is at the proximal position, the arms  562  further spread out from the central portion  550  (i.e., the arms  564  expand radially outward from the central portion  550 ). 
     In this arrangement, the sheath  560  can actuate the arms  562  of the applicator  526  and the protrusions  548  to expand a size of the applicator  526  for delivering cryotherapy and/or the anesthetic agent, and reduce the size of the applicator  526  for inserting and/or withdrawing the applicator  526  in the nasal cavity. Expanding a size of the applicator  526  can allow for a larger treatment area while minimizing the profile of the cryotherapy device  500  during insertion and navigation of narrow aspects of the nasal cavity. This can facilitate reaching particular nerves for treatment. 
     In  FIGS. 2A-5C , the applicator  226 ,  326 ,  426 ,  526  is shown with the protrusions  248 ,  348 ,  448 ,  548  of the applicator  226 ,  326 ,  426 ,  526  having a common length. However, in other examples, the protrusions  248 ,  348 ,  448 ,  548  in  FIGS. 2A-5C  can include a plurality of different lengths. Providing the protrusions  248 ,  348 ,  448 ,  548  with a plurality of different lengths can help to penetrate the target tissue  238  at a plurality of different depths and thus deliver the anesthetic agent  132  to the target tissue  238  at the different depths. This can help to achieve robust anesthetic coverage over a relatively broad tissue region. 
     As one example,  FIG. 6  shows a cryotherapy device  600  that includes an applicator  626  having a plurality of protrusions  648  of a plurality of different lengths (i.e., at least one of the protrusions  648  has a length that is different than a length of another one of the protrusions  648 ). As examples, the different lengths of the protrusions  648  can include approximately 1 mm, approximately 2 mm, and approximately 3 mm from an exterior surface  664  of the applicator  626 . As shown in  FIG. 6 , the applicator  626  is coupled to an elongated shaft  610  and the applicator  626  can include a cryotherapy delivery feature  628 , as described above. In some examples, a length of each of the protrusion(s)  648  can be different (i.e., each protrusion  648  can a respective length and all of the respective lengths can be different than each other). 
     As described above, the protrusions  248 ,  348 ,  448 ,  548 ,  648  can include one or more exit ports  254  that can facilitate delivering the anesthetic agent  132  from the cryotherapy device  100 ,  200 ,  300 ,  400 ,  500 ,  600  to the target tissue  238 .  FIG. 2B  shows an example in which the exit port(s)  254  are located at the tips  256  of the protrusions  248 . However, as described above, the exit port(s)  254  can additionally or alternatively be located on a body of each protrusion  248 ,  348 ,  448 ,  548 ,  648  at one or more positions between the exterior surface of the applicator  226 ,  326 ,  426 ,  526 ,  626  and the tip  256  of the protrusion  248 ,  348 ,  448 ,  548 ,  648 . 
     As an example,  FIG. 7  shows a protrusion  748  that includes one or more exit ports  754  along a body  766  of the protrusion  748 . In the example shown in  FIG. 7 , the exit ports  754  are arranged in a relatively uniform pattern along and around a circumference of the body  766  of the protrusion  748 . This can help to deliver the anesthetic agent  132  in a relatively uniform manner to the target tissue surrounding the protrusion  748 . However, in other examples, the exit ports  754  can be arranged in other patterns. Within examples, the pattern of the exit ports  754  can be based on one or more criteria including, for instance, a type tissue of the target tissue  238 , a size of the target tissue  238 , a shape of the target tissue  238 , a quantity of the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748 , and a spacing between the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748 . 
     In some examples, the cryotherapy devices  100 ,  200 ,  300 ,  400 ,  500 ,  600  described herein can be configured to adjust and/or control a temperature of the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  of the cryotherapy device  100 ,  200 ,  300 ,  400 ,  500 ,  600 ,  700 . Specifically, the cryotherapy devices  100 ,  200 ,  300 ,  400 ,  500 ,  600  can be operable to warm the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  (i.e., apply heat to the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  to increase the temperature of the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748 ). 
     Increasing the temperature of protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  can provide a number of benefits. For example, increasing the temperature of protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  can facilitate the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  penetrating the target tissue  238  after applying cryotherapy to the target tissue  238  (which may be frozen as a result of the cryotherapy applied to the target tissue  238 ). Increasing the temperature of the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  can additionally or alternatively assist in retaining the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  in the target tissue during or after cryotherapy is applied to the target tissue  238 . 
     Additionally or alternatively, it can be beneficial to actively transfer heat from the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  to the target tissue before, during, or following a treatment. For example, after the target tissue  238  has been frozen as a result of a cryoablation procedure, transferring heat from the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  748  to the target tissue  238  can improve patient comfort. 
     Referring now to  FIG. 8 , a cryotherapy device  800  that is configured to apply heat to a plurality of protrusions  848  is shown according to another example. As shown in  FIG. 8 , the cryotherapy device  800  includes an applicator  826  that is coupled to an elongated shaft  810 , as described above. Accordingly, the elongated shaft  810  can include one or more lumens (e.g., the lumen(s)  124 ) that couple the applicator  826  to a cryogen source and/or an anesthetic agent source (e.g., the cryogen source  120  and/or the anesthetic agent source  130  in  FIG. 1 ). 
     In  FIG. 8 , the applicator  826  includes a cryotherapy delivery feature  828  in the form of an expandable member  844  (e.g., a compliant/semi-compliant balloon). As examples, the expandable member  844  of the cryotherapy delivery feature  828  can be constructed of silicone, latex, and/or nylon. As described above, the expandable member  844  can be actuated from a collapsed state to an expanded state by supplying the cryogen from the cryogen source to the expandable member  844  (e.g., via the lumen(s)  124 ). In the expanded state, the expandable member  844  of the cryotherapy delivery feature  828  can use the cryogen to transfer a cold thermal energy to the target tissue  238  (i.e., apply cryotherapy to the target tissue  238 ). 
     Also, in  FIG. 8 , the applicator  826  includes a scaffolding  846 , which can provide structural rigidity to support the expandable member  844 . Increasing or enhancing the structural rigidity of the applicator  826  to support the expandable member  844  can assist in manipulating a position of the applicator  826  with relatively greater precision and control than may be achieved if the expandable member  844  omitted the scaffolding  846 . Increasing or enhancing the structural rigidity can also help to maintain the expandable member  844  in a particular size and/or a particular shape when the expandable member  844  is in the collapsed state. This can, for example, help to position a plurality of protrusions  848  of the applicator  826  in an a particular arrangement for delivering the anesthetic agent  132  to the target tissue  238  while the expandable member  844  is in the collapsed state. 
     As shown in  FIG. 8 , the scaffolding  846  can be located in an internal cavity of the expandable member  844  and extend around a circumference of the expandable member  844  at or near outer peripheral edge of the expandable member  844 . In this example, the scaffolding  846  is made from one or more materials that are electrically conductive and thermally conductive (hereinafter “electrically and thermally conductively material(s)”). For instance, the scaffolding  846  can include a material that is suitably resistive to generate a relatively high degree of heat in response to an electrical current applied to the scaffolding  846 . As examples, the scaffolding  846  can be made from stainless steel and/or Nichrome. 
     In some examples, an entirety of the scaffolding  846  can include the electrically and thermally conductive material(s). In other examples, a first portion of the scaffolding  846  can be made from the electrically and thermally conductive material(s) and a second portion of the scaffolding  846  can be made from a material that is an electrical insulator and/or a thermal insulator (e.g., a plastic material). For instance, in  FIG. 8 , the scaffolding  846  can include a circumferential portion  846 A that extends around the circumference and a central portion  846 B that does not extend around the circumference. In this example, the circumferential portion  846 A is made from the electrically and thermal conductive material(s) and the central portion  846 B is made from a material that is an electrical insulator and/or a thermal insulator. As described further below, this can help to reduce (or minimize) generating heat at the central portion  846 B of the scaffolding  846  at or near a location at which the cryogen  122  enters the expandable member  844 . 
     In still other examples, the central portion  846 B of the scaffolding  846  can be an electrically and thermally conductive material that is electrically isolated from the circumferential portion  846 A. For example, the central portion  846 B can be coupled to the circumferential portion  846 A by one or more non-conductive joints or connectors  868 , electrically isolating the central portion  846 B of the scaffolding  846  from the circumferential portion  846 A. 
     As shown in  FIG. 8 , the scaffolding  846  can also include one or more fenestrations  870  that allow the cryogen  122  (e.g., a compressed liquid cryogen that will expand into a gas at atmospheric pressure) to enter into the expandable member  844  and cool surrounding structures. As described above, the cryogen  122  can enter the cryotherapy device  800  through an intake port of the cryogen source  120  at or proximate to the handpiece  116  (see  FIG. 1 ), and when a valve is shifted to be in an open position (e.g., responsive to operating the user control device(s)  118 ), the cryogen  122  can travel within the lumen(s)  124  of the elongated shaft  810  to reach the fenestration(s)  870 . When the cryogen  122  exits the fenestration(s)  870 , the cryogen  122  can expand into a gas within the expandable member  844 . 
     Additionally, in  FIG. 8 , the applicator  826  can include a plurality of protrusions  848  coupled to the circumferential portion  846 A of the scaffolding  846 . As described above, each protrusion  848  can have a tip that is configured to penetrate the target tissue  238  and/or each protrusion  848  can be made from a material that sufficient column strength to puncture soft tissue without excessive bending or kinking. Additionally, as described above, the protrusions  848  can deliver the anesthetic agent  132  from then anesthetic agent source  130  to the target tissue  238  (e.g., via the lumen(s)  124  in the elongated shaft  110 ). 
     In some examples, the protrusions  848  are comprised of a thermally-conductive material, such as stainless steel. In some examples, the protrusions  848  are comprised of a material that is thermally conductive and has limited electrical conductivity such as, for example, diamond, glass, silicon, and/or ceramic. In other examples, the protrusions  848  can be comprised of a material that is both thermally conductive and electrically conductive, and the protrusions  848  can be coupled to the scaffolding  846  via one or more materials that are thermally-conductive with a high electrical resistivity, thereby substantially electrically-isolating the protrusions  848  from the scaffolding  846 . This can assists in transmitting thermal energy from the protrusions  848  to the target tissue  238  while mitigating (or preventing) transmitting electrical energy from the protrusions  848  to the target tissue  238 . 
     As described above, in some examples, the protrusions  848  can be actuated between the collapsed state and the extended state. In other examples, the protrusions  848  can substantially maintain a fixed position and/or a fixed orientation at all times. Although the protrusions  848  are coupled to the scaffolding  846  in  FIG. 8 , the protrusions  848  can be coupled to one or more other portions of the applicator  826  in other examples. For instance, as one example, one or more of the protrusions  848  can be coupled to the scaffolding  846  near a center of the expandable member  844  proximate to the fenestration  870 . 
     The circumferential portion  846 A of the scaffolding  846  is coupled to two electrical lead wires  872 . In  FIG. 8 , the electrical lead wires  872  extend though at least one of the lumen(s)  124  in elongated shaft  810  to reach the handpiece (e.g., the handpiece  116  shown in  FIG. 1 ). In some examples, the electrical lead wires  872  can be encased in an insulating material except for at the connection points found at each respective end of the electrical lead wires  873 . In some examples, the electrical lead wires  872  can be coupled to the circumferential portion  846 A of the scaffolding  846  in series or in parallel with a resistor, capacitor, or other electrical component. 
     Within or proximate to the handpiece, the electrical lead wires  872  can be coupled to opposite polarity terminals of an electrical power source (e.g., a battery and/or a power input module for adapting wall mains power). Additionally, within examples, the user control device(s)  118  shown in  FIG. 1  can include an electrical switch coupled to the electrical lead wires  872  (e.g., in series with the power source), and actuatable between a first state and a second state. In the first state, the electrical switch is in an open position so that an electrical circuit is broken and no electrical current flows along the electrical lead wires  872  to the scaffolding  846 . In the second state, the electrical switch completes the electrical circuit and causes an electrical current to flow from the power source through the electrical lead wires  872  to the circumferential portion  846 A of the scaffolding  846 . While current is flowing through the scaffolding  846 , the scaffolding  846  transduces the electrical current into heat due to resistive heating (also known as Joule heating). 
     As the protrusions  848  and the scaffolding  846  are made from thermally conductive material(s), the protrusions  848  are thermally coupled to the scaffolding  846 . Thus, responsive to the scaffolding  846  transducing the electrical current to the heat, the scaffolding  846  transmits the heat to the protrusions  848 . Responsive to the heat received from the scaffolding  846 , a temperature of the protrusions  848  increases. The protrusions  848  can further transmit the heat to the target tissue  238  as described above. 
     As described above, in implementations in which the central portion  846 B is electrically isolated from the circumferential portion  846 A of the scaffolding  846 , the electrical current does not flow to the central portion  846 B of the scaffolding  846 . This can mitigate (or prevent) a risk of a short of the terminals of the electrical power source, reducing (or preventing) temperature elevations in the central portion of the delivery element. When desired, a user can operate the user control device(s)  118  to actuate the electrical switch from the second state back to the first state, thereby terminating the electrical current in the scaffolding  846  and cease generating the heat. 
     As described above, in some examples of the cryotherapy device  800  can allow for warm temperatures created from resistive heating of the circumferential portion  846 A of the scaffolding  846  to reach the protrusions  848  while substantially keeping the protrusions  848  electrically isolated, thereby eliminating or substantially-eliminating any electrical current that could flow through the protrusions  848  into materials that the protrusions contact, for example into the patient&#39;s body. 
     Preferred examples will be configured such that the combination of material resistivity and power source voltage/current characteristics will result in mild temperature rises in the protrusions  848 , for example temperature rises of less than 10° C. In some implementations, temperature rises in protrusions  848  can be equal to or less than approximately 1 degree Celsius to approximate 3 degrees Celsius. In general, the cryotherapy device  800  can be configured such that temperature rises induced by resistive heating do not melt or otherwise alter the expandable member  844  (or any other temperature sensitive element of the cryotherapy device  800 ). 
     Within examples, the cryotherapy device  800  can be operable to deliver the heat to the protrusions  848  before, during, and/or after insertion of the protrusions  848  into the target tissue  838 . In some examples, the cryotherapy device  800  can warm the protrusions  848  only prior to inserting the protrusions  848  into the target tissue  838 . In other examples, the cryotherapy device  800  can warm the protrusions  848  only after inserting the protrusions  848  in the target tissue  838 . Warming the protrusions  848  can help to reduce a treatment time and improve a workflow for a physician. 
     Also, within examples, the user control device(s)  118  (including the electrical switch) can be operable to supply the electrical current from the electrical power source to the scaffolding  846  such that the scaffolding generates the heat continuously or intermittently in response to operation of the user control device(s)  118 . For instance, in one example, the electrical power source can include a pulse width modulator that can convert a direct current power into a pulsed electrical signal. Other examples are also possible. In some implementations, providing continuous power can generate heat faster than pulsed power. However, pulsed power can provide a more gradual and more uniform temperature rise (and may additionally or alternatively provide for using a relatively lower-grade battery and/or drive system). 
     In some examples, the cryotherapy device  800  can include one or more sensors (e.g., one or more temperature sensors and/or one or more conductivity sensors) located the protrusions  848  or in another location on the cryotherapy device  800 . In such examples, the sensor(s) can assist with determining whether or not the protrusions  848  have contacted and/or penetrated the target tissue  238 , and/or whether warming should be enabled or disabled. For example, a conductivity sensor can measure the electrical impedance between different locations on a protrusion  848 , or the electrical impedance between two or more protrusions  848 , and compare the result to a threshold value that has been pre-programmed. Based on the comparison, the cryotherapy device  800  can determine that the protrusion  848  has penetrated tissue. This can help to mitigate a scenario where the protrusions  848  are warmed when the protrusions  848  are not in the desired or anticipated anatomical position, which could impact the efficacy of the procedure and/or have other unintended consequences. 
     As described above, the distal portion  914  is an implementation of the distal portion  114  of the cryotherapy device  100  shown in  FIG. 1 . In the examples described above, the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  848  generally extend from the applicator  226 ,  326 ,  426 ,  526 ,  626 ,  826  and the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  848  can be fluidly coupled to the anesthetic agent source  130  via at least one of the lumen(s)  124  in the elongated shaft  110  shown in  FIG. 1 . However, in other examples, the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  848  can be located at other locations of the cryotherapy device  100 ,  200 ,  300 ,  400 ,  500 ,  600 ,  800  and/or the protrusions  248 ,  348 ,  448 ,  548 ,  648 ,  848  can be coupled to the anesthetic agent source  130  by one or more conduits that are external to the elongated shaft  110 . 
     Referring now to  FIGS. 9A-9C , a distal portion  914  of a cryotherapy device  900  is shown according to another example. In particular,  FIG. 9A  shows the cryotherapy device  900  with a needle  948  in a retracted state,  FIG. 9B  shows the cryotherapy device  900  with the needle in an extended state, and  FIG. 9C  shows a cross-sectional view of the cryotherapy device  900 . 
     As shown in  FIGS. 9A-9C , the cryotherapy device  900  includes an applicator  926  coupled to an elongated shaft  910 , and the applicator  926  includes a cryotherapy delivery feature  928 . As described above, the cryotherapy delivery feature  928  can be coupled to the cryogen source  120  via the lumen(s)  924  in the elongated shaft  910 . Also, as described above, the cryotherapy delivery feature  928  can include an expandable member and/or an active surface (e.g., made from a metal) that can use the cryogen  122  to transfer cold thermal energy to the target tissue. In another example, the cryotherapy delivery feature  928  can include a thermoelectric device that is configured to generate cold thermal energy (e.g., via the Peltier effect or a similar process). 
     As shown in  FIGS. 9A-9B , the cryotherapy device  900  also includes the needle  948 , which can deliver the anesthetic agent  132  to the target tissue. For example, the needle  948  can include an internal lumen  924  ( FIG. 9C ) that extends between a tip  956  at a distal end of the needle  948  and the anesthetic agent source  130  at a proximal end of the needle  948 . As described above, the tip  956  can be configured to pierce and penetrate the target tissue such that the needle  948  can deliver the anesthetic agent  132  to the target tissue. For instance, the tip  956  can have a shape that tapers inwardly to a point. 
     For instance, the needle  948  can have a gauge between 25 gauge and 30 gauge. Additionally, for instance, the needle  948  can be comprised of a material that retains sufficient column strength to puncture soft tissue without bending and/or kinking (e.g., nitinol or thin walled stainless steel tubes). 
     In  FIGS. 9A-9B , the needle  948  extends along an exterior surface of the elongated shaft  910 . More specifically, the needle  948  is translatable along the elongated shaft  910  between a proximal position shown in  FIG. 9A  and a distal position shown in  FIG. 9B . As shown in  FIG. 9A , the tip  956  of the needle  948  can be positioned proximal of a distal end  936  of the elongated shaft  910  in the proximal position (i.e., when the needle  948  is the retracted state). As shown in  FIG. 9B , the tip  956  of the needle  948  can be positioned distal of the distal end  936  of the elongated shaft  910  in the distal position (i.e., when the needle  948  is the extended state). 
     More generally, (i) in the retracted state shown in  FIG. 9A , the tip  956  of the needle  948  can be at a first distance from the applicator  926 , (ii) in the extended state shown in  FIG. 9B , the tip  956  of the needle  948  can be at a second distance from the applicator  926 , and (iii) the second distance can be greater than the first distance. 
     In this arrangement, the needle  948  can be in (i) the retracted position while inserting the cryotherapy device  900  in a nasal cavity and withdrawing the cryotherapy device  900  from the nasal cavity, and (ii) in the extended position while penetrating and delivering the anesthetic agent  132  to the target tissue. 
     To facilitate translating the needle  948  between the retracted state and the extended state, the cryotherapy device  900  can include a needle guide system. For example, in  FIGS. 9A-9B , the cryotherapy device  900  includes a plurality of guide hooks  974  along the exterior surface of the elongated shaft  910 . In  FIGS. 9A-9C , the guide hooks  974  are coupled to the elongated shaft  910  such that the guide hooks  974  and the exterior surface of the elongated shaft  910  define a plurality of apertures  976  that are axially aligned with each other. Although the apertures  976  are defined by a combination of the guide hooks  974  and the elongated shaft  910  in  FIGS. 9A-9C , the apertures  976  can be defined by only the guide hooks  974  in other examples. 
     As shown in  FIGS. 9A-9C , the needle  948  extends through one or more of the apertures  976  defined by the guide hooks  974  in the retracted state and the extended state. In this arrangement, the guide hooks  974  can assist in retaining the needle  948  in a plane that is substantially parallel to a plane in which the elongated shaft  910  is positioned when the needle  948  is in the retracted state. The guide hooks  974  can also assist in retaining the needle  948  against the elongated shaft  910  while translating the needle  948  from the proximal position shown in  FIG. 9A  to the distal position shown in  FIG. 9B . Thus, the guide hooks  974  can define a first portion of a path for translating the needle  948  along an axis of extending through the apertures  976 , which is substantially parallel to a longitudinal axis of the elongated shaft  910 . 
     As shown in  FIGS. 9A-9B , the needle guide system can also include a needle guide ramp  978  at or near the distal end of the elongated shaft  910 . In general, the needle guide ramp  978  can be configured to guide the needle  948  along a second portion of the path that is transverse to the first portion of the path (i.e., defined by the axis extending through the apertures  976 ). In other words, the needle guide ramp  978  can be configured to bend the needle  948  as the needle  948  moves distally through the guide hooks  974  and along the elongated shaft  910  (i.e., diverting the tip  956  of the needle  948  from the axis of the apertures  976 ). This can beneficially help to direct the tip  956  of the needle  948  away from the elongated shaft  910  and/or towards the target tissue. 
     For example, as shown in  FIGS. 9A-9B , a first end of the needle guide ramp  978  can located in-line with the axis of the apertures  976  and the needle guide ramp  978  can bend towards a second end of the needle guide ramp  978 , which is located outward of the first end relative to the elongated shaft  910 . In this arrangement, the needle guide ramp  978  can direct the needle  948  along a plane transverse to the plane of the elongated shaft  910 . This can also help to deliver the anesthetic agent  132  to a portion of the target tissue that is adjacent to another portion of the target tissue to which the cryotherapy delivery feature  928  applies the cold thermal energy during cryotherapy. 
     As shown in  FIG. 9A , the needle guide ramp  978  can extend over the tip  956  of the needle  948  when the needle  948  is at the proximal position. This can help to inhibit (or prevent) the needle  948  piercing and/or penetrating a tissue other than the target tissue while inserting the cryotherapy device  900  and/or while withdrawing the cryotherapy device  900  from the nasal cavity. 
     In  FIG. 9C , the elongated shaft  910  has a circular cross-sectional shape. However, in another example, the exterior surface of elongated shaft  910  can include a hemi-cylindrical recess in which the needle  948  can be positioned. The hemi-cylindrical recess can allow for the needle  948  to translate along the elongated shaft  910  while reducing (or minimizing) a contribution of the needle  948  to an outer diameter of the cryotherapy device  900 . 
     In some implementations, the needle  948  can be an integral component of the cryotherapy device  900  that can be moved along the elongated shaft  910 . That is, the needle  948  can be coupled to the guide hooks  974  such that the needle  948  cannot be removed from the guide hooks  974 . In other implementations, the needle  948  can be a separate component of a cryotherapy device  900  that can be repeatedly inserted into and/or removed from the guide hooks  974 , and/or replaced by another needle  948 . This can help to provide for the applicator  926  as a reusable component, and the needle  948  as a single-use component. 
       FIG. 10  shows a cryotherapy device  1000  according to another example. The cryotherapy device  1000  is substantially similar or identical to the cryotherapy device  900  of  FIG. 9 , except the cryotherapy device  900  includes a needle  1048  that is internal to an applicator  1026  and an elongated shaft  1010 . The applicator  1026  is coupled to the elongated shaft  1010 , and includes a cryotherapy delivery feature  1028  as described above. As shown in  FIG. 10 , the cryotherapy device  1000  also includes a needle guide ramp  1078  in an internal cavity of the applicator  1026 . As described above, the needle guide ramp  1078  is configured to divert the needle  1048  from a first portion of a path along an axis (e.g., a longitudinal axis of the elongated shaft  1010 ) to a second portion of the path transverse to the axis. Specifically, in  FIG. 10 , the needle  1048  protrudes from the cryotherapy delivery feature  1028  at an angle that is substantially normal to a surface of the cryotherapy delivery feature  1028 . This can help to apply the anesthetic agent  132  and the cool thermal energy to a common portion of the target tissue. 
     In  FIG. 10 , the needle  1048  is shown in an extended position. However, the needle  1048  can be translatable along the path defined by the needle guide ramp  1078  and the longitudinal axis of the elongated shaft  1010 . In the retracted position, the needle  1048  can be positioned such that a tip  1056  of the needle  1048  is not exposed (i.e. the tip  1056  can be recessed within the applicator  1026 ). 
     Referring now to  FIGS. 11A-11C , a cryotherapy device  1100  is shown according to another example. Specifically,  FIG. 11A  shows a distal portion  1114  of the cryotherapy device  1100  ( i ) having a needle  1048  in a retracted state and (ii) in contact with a target tissue  1138  (e.g. upper airway mucosa/submucosa) overlying a semi-rigid structure  1180  (e.g. cartilage or bone).  FIG. 11B  shows a cross-sectional view of the cryotherapy device  1100  shown in  FIG. 11A .  FIG. 11C  shows the distal portion  1114  of the cryotherapy device  1100  ( i ) having the needle  1048  in an extended state and (ii) in contact with the target tissue  1138  overlying the semi-rigid structure  1180 . 
     The cryotherapy device  1100  includes a cryotherapy delivery feature  1128  that can deliver cryotherapy to the target tissue  1138 . The cryotherapy device  1100  also includes an elongated shaft  1110  coupling the cryotherapy delivery feature  1128  to a handpiece (e.g., the handpiece  116 ). The elongated shaft  1110  is shaped so that the cryotherapy delivery feature  1128  is off-axis to a central axis of the cryotherapy device  1100  (i.e., a longitudinal axis of the elongated shaft  1110  is in a different plane than a longitudinal axis of the cryotherapy delivery feature  1128 ). To facilitate shaping the elongated shaft  1110 , the elongated shaft  1110  can be (i) semi-flexible and pre-shaped by a manufacturer, (ii) constructed of malleable material so shape can be defined by the user, and/or (iii) comprised of a multi-flexible shaft with articulating features that allow the user to flex and bend the elongated shaft  1110  during delivery and adjust a shape while the elongated shaft  1110  is in the patient. For instance, the elongated shaft  1110  can be made from a material that can be manipulated to adjust a shape of the elongated shaft  1110  and then retain the shape after being manipulated. 
     As shown in  FIGS. 11A-11C , the cryotherapy device  1100  can include a needle guide system to assist translating the needle  1048  between the retracted state and the extended state, as described above. For instance, in  FIGS. 11A-11C , the cryotherapy device  1100  can include a needle conduit  1182  coupled to the elongated shaft  1110 . The needle conduit  1182  can have a size and a shape that allows the needle  1048  to be positioned and translate in the needle conduit  1182 . In one example, the needle  1148  can have a gauge between 25 gauge and 30 gauge (e.g., the needle  1148  can be a relatively thin-walled metallic tube). Also, as an example, the needle conduit  1182  can have a diameter that is between approximately 0.05 mm and approximately 0.15 mm larger than an outer diameter of the needle  1148 . This can help ensure that the needle  1148  can translate through the needle conduit  1182  while still providing the needle  1148  with a diameter that can achieve sufficient column support to facilitate piercing and penetrating the target tissue  1138 . 
     In an example, the needle conduit  1182  can be comprised of shapeable material such as, for instance, a heat shaped polymer. In one implementation, the needle conduit  1182  and a jacket of the elongated shaft  1110  can be made from a single extruded multi-lumen. A distal end of the needle conduit  1182  can be proximal of the cryotherapy delivery feature  1128  and a proximal end of the needle conduit  1182  can be at the handpiece (e.g., the handpiece  116 ). 
     As shown in  FIG. 11B , the needle conduit  1182  and the needle  704  are aligned in the opposite plane of a bend in the elongated shaft  1110  (e.g., the needle  704  can be on top or on bottom of the elongated shaft  1110  and have a shape that corresponds to the bend of the elongated shaft  1110 ). The elongated shaft  1110  can include an outer lumen  1124 A and an inner lumen  1124 B, which is concentric with and inside of the outer lumen  1124 A. In the inner lumen  1124 B is a cryogen lumen  1124 C that can deliver a cryogen (e.g., the cryogen  122 ) to the cryotherapy delivery feature  1128 . In this example, an exhaust from the cryogen can return proximally through the inner lumen  1124 B. 
     In  FIG. 11B , the outer lumen  1124 A and the inner lumen  1124 B are separated by a gap. The gap can provide insulation along the elongated shaft  1110  to help reduce (or prevent) the elongated shaft  1110  and the needle conduit  1182  from decreasing in temperature to a temperature level that may ablate tissue outside of the target tissue  1138 . The gap can also help inhibit (or prevent) an anesthetic agent (e.g., the anesthetic agent  132 ) in needle  1148  from freezing. 
     As noted above,  FIG. 11A  shows the needle  1148  in the retracted state and  FIG. 11C  shows the needle  1148  in the extended state. As shown in  FIG. 11A , when the needle  1148  is in the retracted state, the needle  1148  can be completely retracted within the needle conduit  1182 , allowing the cryotherapy delivery feature  1128  to make contact with the target tissue without piercing the target tissue  1138 . As shown in  FIG. 11C , when the needle  1148  is in the extended state, a tip  1156  of the needle  1148  is advanced more distally into the target tissue  1138 . 
     In some implementations, the needle  1148  can be an integral component of the cryotherapy device  1100  that can be moved along the elongated shaft  1110 . That is, the needle  1148  can be coupled to the needle conduit  1182  such that the needle  1148  cannot be removed from the needle conduit  1182 . In other implementations, the needle  1148  can be a separate component of a cryotherapy device  1100  that can be repeatedly inserted into and/or removed from the needle conduit  1182 , and/or replaced by another needle in the needle conduit  1182 . 
     Referring now to  FIG. 12 , a flowchart of a method  1200  for delivering an anesthetic agent to a target tissue in a nasal cavity of a patient is shown according to an example. As shown in  FIG. 12 , the method  1200  can include inserting a cryotherapy device into the nasal cavity of the patient at block  1210 . The cryotherapy device can include a cryotherapy delivery feature and one or more protrusions. At block  1212 , the method  1200  can include positioning the cryotherapy delivery feature in contact with the target tissue. At block  1214 , the method  1200  can include delivering, using the cryotherapy delivery feature, a cryotherapy treatment to the target tissue. After inserting the cryotherapy device into the nasal cavity at block  1210 , the method  1200  can include actuating the one or more protrusions from a retracted state to an extended state at block  1216 . After actuating the one or more protrusions to the extended state at block  1216 , the method  1200  can include penetrating the target tissue with the one or more protrusions at block  1218 . After penetrating the target tissue at block  1218 , the method  1200  can include delivering, via the one or more protrusions, an anesthetic agent into the target tissue. 
     In some examples, penetrating the target tissue at block  1218  can be performed prior to delivering the cryotherapy treatment at block  1214 . This can help to reduce a force for penetrating the target tissue as the target tissue can become more difficult to penetrate after delivering the cryotherapy to the target tissue. In some implementations, the protrusions can remain in the target tissue while delivering the cryotherapy and for at least a period of time after delivering the cryotherapy at block  1214 . This can allow for a plurality of modes of operation (e.g., applying anesthesia prior to cryotherapy and then warming (with or without additional anesthesia after cryotherapy). In other examples, penetrating the target tissue at block  1218  can be performed only after delivering the cryotherapy at block  1214 . This may be beneficial in instances in which the protrusions may interfere with cryotherapy. In some examples, the method  1200  can include delivering the cryotherapy treatment at block  1214  and delivering the anesthetic agent at block  1218  simultaneously. 
       FIGS. 13-14  depict additional aspects of the method  1200  according to further examples. As shown in  FIG. 13 , the method  1200  can also include (i) generating heat in a scaffolding of the cryotherapy device at block  1220 , (ii) transferring the heat from the scaffolding to the one or more protrusions at block  1222 , and (iii) transferring the heat from the one or more protrusions to the target tissue at block  1224 . As shown in  FIG. 14 , generating the heat in the scaffolding at block  1220  can include transducing an electrical current via resistive heating at block  1226 . 
     In the examples described above, the method  1200  involves delivering the anesthetic agent to the target tissue via the protrusions. However, in other examples, the method  1200  can include delivering a non-pharmaceutical agent is delivered to the target tissue. As examples, the non-pharmaceutical agent can include water or saline. 
     In some examples of methods or devices described herein, the cryotherapy device can be adapted such that the insertion of protrusions such as needles into tissues can be gradual with time and/or performed at an adjustable length based upon a user action. For example, rotating a dial or otherwise manipulating a control feature on or proximate to a device handpiece can slowly expand or deploy a needle protrusion into tissue, allowing for precise control of penetration depth and thereby precise control over the depth and types of tissue impacted by the therapies delivered via the protrusions. 
     In some examples of the methods or devices described herein, the protrusions at the distal end of the device are adapted to provide cooling and in effect serve as the cryotherapy delivery element(s). In some examples, the protrusions can be adapted to deliver both cooling and heating energy based upon a user input or the user manipulating a control feature proximate to the handpiece of the device. 
     Though the disclosures presently-disclosed have primarily been discussed in the context of cryotherapy, the devices, systems, and methods described can have applicability with other ablative and non-ablative surgical techniques. For example, examples can include devices, systems, and methods that utilize heating/hyperthermia therapies. Examples utilizing heating/hyperthermia therapies can be similar in structure and steps as examples utilizing hypothermic therapies. Sources of heat for use with hyperthermia-based therapies can include RF energy, microwave energy, ultrasound energy, resistive heating, exothermic chemical reactions, combinations thereof and other heat sources known to those skilled in the art. Further, the disclosure can be applied as a standalone system or method, or as part of an integrated medical treatment system. It shall be understood that different aspects of the disclosure can be appreciated individually, collectively, or in combination with each other. 
     The methods described herein can be utilized effectively with any of the examples or variations of the devices and systems described above, as well as with other examples and variations not described explicitly in this document. The features of any of the systems or system components described in any of the examples herein can be used in any other suitable example of a system or system component. 
     The description of the different advantageous arrangements has been presented for purposes of illustration and description, and is not intended to be exhaustive or limited to the examples in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art. Further, different advantageous examples may describe different advantages as compared to other advantageous examples. The example or examples selected are chosen and described in order to explain the principles of the examples, the practical application, and to enable others of ordinary skill in the art to understand the disclosure for various examples with various modifications as are suited to the particular use contemplated.