Patent Description:
Described herein are implants for placement in a body, tools for delivering the implants, and systems and methods for using the implants and tools. More particularly, described herein are nasal implants, tools for delivering nasal implants, and systems and methods for using such implants and tools.

The particular nasal anatomy of an individual may cause or contribute to various problems, such as cosmetic concerns, difficulty breathing, sleep apnea, or snoring, and can impact an individual's health or reduce the quality of life. For example, the structure of an external or internal nasal valve may resist airflow from the nose to the lungs and prevent an individual from getting sufficient oxygen to the blood.

Nasal valve collapse is a frequent cause of nasal airway obstruction, characterized by a loss of support from lateral nasal cartilages typically observed following rhinoplasty, nasal trauma, or age. Properly functioning nasal cartilage acts to keep the nasal passages open. If the lateral cartilages become weak, they collapse inward when a person inhales due to the negative pressure from the flow of air. This problem is currently largely untreated due to the complexity and highly variable results associated with current repair techniques, combined with the fact that a majority of patients are elderly or have a history of nasal surgery.

Overall, nasal valve collapse is an oftentimes untreated problem due to inconsistent results from a myriad of complex procedures performed by very few surgeons. As such, there remains a need for an endoscopic method to repair nasal valves in a simple, consistent manner. There is also a continued need for improvements to address problems attributed to nasal anatomy that are easy to use, long lasting, minimally invasive, low cost, and effective. There is also a continued need to improve the delivery of the nasal implant and for improved delivery tools for delivering nasal implants.

Prior art is known from <CIT>, <CIT>, <CIT>, and <CIT>. In particular, <CIT> discloses a delivery tool in which a nasal implant can be loaded. The delivery tool includes a handle portion and a needle disposed distal to the handle portion, and the loading step includes loading the implant into the handle portion and advancing the implant into the needle.

Described herein are tools for delivering implants, systems including delivery tools and nasal implants, and methods for using the delivery tools for placing implants in a body. More particularly, described herein are nasal implants, tools for delivering nasal implants, and systems and methods for using such implants and tools. Also described herein are nasal implant positioning guides. The present invention provides a nasal implant delivery tool according to claim <NUM>. The dependent claims <NUM> to <NUM> define preferred implementations of the invention. Although methods of operation are not explicitly recited by the wording of the claims, they are considered useful for understanding the invention.

In general, in one example, a nasal implant delivery tool includes an inner handle, an outer handle, a needle, and a push rod. The inner handle includes a loading chamber configured to receive a nasal implant. The outer handle is configured to move axially relative to the inner handle. The needle extends distally from the inner handle and has a central lumen and a distal opening. The push rod is configured to move the nasal implant from the loading chamber, through the central lumen, and out the distal opening of the needle. The push rod is coupled to the outer handle such that the push rod moves axially relative to the inner handle when the outer handle is moved axially relative to the inner handle.

This and other examples can include one or more of the following features. A distal end of the needle can include a flat bevel tip. A distal end of the needle can include a sharpened tip. The sharpened tip can include two or more surfaces having a bevel of <NUM> degrees or less. The outer handle can be configured to move between a plurality of discrete locking positions relative to the inner handle. The locking positions can correspond to a distal deployed position, a primed position, and proximal implant loading position. The push rod can be advanced distally such that the nasal implant is configured to be advanced partially or completely past the distal opening of the needle when the outer handle is in the distal deployed position. The central lumen of the needle can be configured to hold the nasal implant therein when the outer handle is in the primed position. The loading chamber can be exposed when the outer handle is in the proximal implant loading position. The delivery tool can further include a first button and a second button on the outer handle. The first button can be configured to allow the outer handle to move from the primed position to the distal deployed position when the first button is depressed. The first button can include a first locking feature configured to engage with a second locking feature on the inner handle to prevent the first button from being depressed when the outer handle is in the implant loading position. The second button can be configured to allow the outer handle to move from the primed position to the proximal implant loading position when the second button is depressed. The first button or the second button can include an engaging surface configured to engage with a corresponding engagement surface of the inner handle when the first or second button is not depressed. The first or second button can be configured to move the engaging surface when the first or second button is depressed such that the engaging surface disengages with the corresponding engagement surface of the inner handle to allow relative movement between the inner handle and the outer handle. The delivery tool can further include an implant orientation indicator configured to indicate an orientation of the nasal implant within the delivery tool. The implant orientation indicator can include a first arm projecting from the delivery tool in a first direction and a second arm projecting from the delivery tool in a second direction. The first arm and second arm can define a plane that can be substantially similar to the plane formed by a first arm and a second arm of the nasal implant in the deployed configuration. The needle can include a low friction coating on an external surface of the needle. The low friction coating can include PTFE, silicone, or poly(p-xylylene). The needle can include banded markings at various positions along the needle. The central lumen of the needle can include a portion having a non-circular cross-section. The outer handle can be configured to fully sheath a proximal end of the inner handle. The outer handle can include a grip configured to be manually held by a user.

In general, in one example, a method of delivering a nasal implant to nasal tissue includes: (<NUM>) inserting a needle of a delivery tool into nasal tissue, where the delivery tool includes an inner handle housing a nasal implant therein; (<NUM>) advancing an outer handle of the delivery tool distally relative to the inner handle while maintaining a position of the inner handle so as to advance the implant distally through a needle of the delivery tool and into the nasal tissue; and (<NUM>) withdrawing the delivery tool from the nasal tissue.

This and other examples can include one or more of the following features. The implant can include a first arm at a distal end of the implant and a second arm at the distal end of the implant, the first arm moving away from a central longitudinal axis of the implant and the second arm moving away from the central longitudinal axis of the implant during the advancing step. Advancing the implant can include pushing the implant distally such that the first arm and second arm each engage the tissue. The method can further include advancing the outer handle to a distal locking position prior to withdrawing the delivery tool from the nasal tissue. The method can further include sliding the outer handle proximally relative to the inner handle to expose an implant loading chamber of the inner handle prior to inserting the needle. The method can further include loading the implant into the implant loading chamber of the delivery tool after the implant loading chamber is exposed. The method can further include pressing a button on the outer handle to unlock the outer handle from the inner handle prior to sliding the outer handle proximally to expose the implant loading chamber. The method can further include pressing a button on the outer handle to unlock the outer handle from the inner handle prior to advancing the outer handle of the delivery tool distally. The method can further include maintaining a known orientation between the implant and the needle during the inserting step. Maintaining the known orientation between the implant and the needle can include engaging the implant with a portion of a lumen of the needle having a non-circular cross section. The method can further include using a nasal implant guide to plan a position and an orientation of the nasal implant prior to inserting the needle.

In general, in one example, a nasal implant guide includes a nasal implant guide portion and a handle. The nasal implant guide portion includes a proximal opening, a plurality of markings, a distal opening, and a forked feature. The proximal opening is configured to allow a mark to be made on the nasal lateral wall of a patient and corresponds to a proximal feature of a nasal implant. The plurality of markings are adjacent the proximal opening and are adapted to provide a ruler for a physician to judge a distance between the proximal feature and an alar rim edge. The distal opening is configured to allow a mark to be made on the nasal lateral wall of a patient and corresponds to a base of a distal fork of the nasal implant. The forked feature projects distally from the distal opening and corresponds to an expanded configuration of the distal forked feature of the nasal implant. The handle is engaged with the nasal implant guide portion and is configured to be hand graspable to position the nasal implant guide portion relative to the nasal lateral wall.

This and other example can include one or more of the following features. The nasal implant guide portion can further include an image of a portion of a shape of the nasal implant. The handle can be engaged with the nasal implant guide portion such that the handle forms about a <NUM> degree angle to a dominant axis of the nasal implant guide portion. The forked feature can include a first projection and a second projection.

In general, in one example, a system includes any of the delivery tools as described herein and a nasal implant as described herein. The system can further include any of the nasal implant guides described herein.

Described herein are nasal implants, delivery tools for delivering nasal implants, methods of using the implants, methods of using the tools to deliver a nasal implant, and external nasal guides to assist in placement of the nasal implants. The delivery tools, devices, systems, and methods described herein can provide various advantages and improvements. For example, the delivery tools can provide improved ergonomics and one handed use. The improved ergonomics can reduce the likelihood of incomplete nasal implant deployment and/or incorrect positioning of the nasal implant. The improved ergonomics can also make maintaining the positioning and orientation of the needle easier such that retraction of the tool is less likely to move the implant or change the orientation of the implant.

Embodiments of nasal implant delivery tools are described herein. In some embodiments, the nasal implant delivery tools include an inner handle including an implant loading chamber configured to receive a nasal implant and an outer handle configured to be hand graspable that is configured to move axially relative to the inner handle portion. The nasal implant delivery tools can include a needle extending distally from a portion of the inner handle with the needle. In some embodiments, the needle can have a non-circular cross-section. The non-circular cross-section can serve as an implant orientation feature such that the nasal implant traverses the lumen with a fixed and known rotational orientation. The device can include an opening or pathway between the implant loading chamber and the proximal end of the needle adapted to allow the implant to move from the implant loading chamber to a position within the needle. In one example, the needle can be adjunct to the loading chamber and a loading ramp which can compress the implant arms for entry into the lumen of the needle. The nasal implant delivery tool can include a plunging element/actuator (e.g., a push rod) configured to move the nasal implant from the loading chamber, into and along the needle lumen, and out of an opening at the distal end of the needle. The plunging element/actuator can be engaged with or coupled to the outer handle such that the plunging element/actuator moves axially relative to the inner handle portion with axial movement of the outer handle portion. The outer handle can be adapted to move between a plurality of discrete locking positions relative to the inner handle, e.g., using one or more buttons.

In some embodiments, the nasal implant delivery tool can include an implant orientation indicator configured to provide a visual indication of a plane formed by a first arm and a second arm of the nasal implant in the deployed configuration corresponding to the orientation of the implant within the needle lumen. The inner handle portion can include an implant orientation indicator configured to provide a visual indication of a plane formed by a first arm and a second arm of the nasal implant in the deployed configuration corresponding to the orientation of the implant within the needle lumen. The implant orientation indicator can be designed so that the operator of the tool can quickly see the orientation of the tool and the corresponding orientation of the plane formed by the arms of the nasal implant in the deployed configuration. The implant orientation indicator can extend from a portion of the handle such that the operator's hand does not cover or obscure the implant orientation indicator during use of the device. The implant orientation indicator can include a first arm projecting from the handle in a first direction and a second arm projecting from the handle in a second direction. The first arm and second arm can define a plane that is substantially similar to the plane formed by the first arm and the second arm of the nasal implant in the deployed configuration corresponding to the orientation of the implant within the needle lumen.

In some embodiments, the implant loading chamber is configured to receive a nasal implant in a deployed configuration. Further, the implant loading chamber can be adapted to move the nasal implant from an expanded configuration to a compressed delivery or primed configuration as the nasal implant is advanced into the needle lumen. A ramp between the implant loading chamber and the needle can be configured to move the arms of the implant to the compressed delivery configuration within the needle lumen.

In some embodiments, the needle includes a low friction coating on an external surface of the needle. In some examples, the low friction coating can be polytetrafluoroethylene (PTFE), silicone, or poly(p-xylylene). In some embodiments, the needle includes substantially banded markings at various positions along the needle. The banded markings can provide information to the physician relating to the depth and positioning of the needle within the nasal tissue.

In some embodiments, the nasal implant delivery tool can include the nasal implant therein. A implant can include any of the nasal implants described herein. In one example, a nasal implant for use with the loading tools described herein includes a body having a distal end, a proximal end, and a central portion disposed between the proximal end and the distal end. The implant further includes a first arm and a second arm. The first arm is disposed at the distal end and has a proximal end fixed to the body and a distal end not fixed to the body, and the distal end of the arm is adapted to move away from a central longitudinal axis of the body from a delivery configuration toward a deployed configuration. The second arm includes a proximal end fixed to the body and a distal end not fixed to the body, and the distal end of the second arm is adapted to move away from a central longitudinal axis of the body from a delivery configuration toward a deployed configuration. The first arm and second arms can define a plane when in the deployed configuration where the arms are away from the central longitudinal axis of the body.

Methods of supporting a tissue section of a patient's nose are also provided herein. In some embodiments, the method includes inserting a needle of a delivery tool as described herein into a tissue of the nose. The method can include advancing the outer handle distally to advance the implant distally from the needle lumen to place a distal end of the implant within the nasal tissue. The implant can include a first arm at a distal end of the implant and a second arm at the distal end of the implant. The method can include the first arm moving away from a central longitudinal axis of the implant during the advancing step, the second arm moving away from the central longitudinal axis of the implant during the advancing step. The method can include withdrawing the delivery tool from the nasal tissue and supporting the tissue section with the implant.

In some embodiments, the method can further include advancing the outer handle to a distal locking position prior to withdrawing the delivery tool from the nasal tissue. The use of the distal locking position can prevent the physician from advancing the outer handle incompletely because if the distal locking position is not reached, then the outer handle will slide during retraction informing the physician that the implant was not fully deployed. The method can further include sliding the outer handle proximally to expose the implant loading chamber of the inner handle portion. The method can also include pressing a button on the outer handle to unlock the outer handle from the inner handle portion prior to sliding the outer handle proximally to expose the implant loading chamber. Additionally, the method can include loading the implant into the implant loading chamber of the delivery tool. The loading step can include collapsing the first arm and second arm of the implant prior to entering the needle. The method can further include advancing the implant from the implant loading chamber into the needle lumen by advancing the outer handle and plunging element/actuator distally relative to the inner handle portion. Advancing the implant can include advancing the outer handle to a locking point followed by unlocking the outer handle prior to advancing the implant distally from the needle lumen to place the distal end of the implant within the nasal tissue. The method can include unlocking and advancing the outer handle portion independent of the inner handle portion while preventing needle and inner handle movement relative to the nasal anatomy. Unlocking the outer handle can include depressing a button on the outer handle to disengage the outer handle from a locking surface of the inner handle portion.

Systems are also described herein. The systems can include any of the delivery tools described herein and a nasal implant. The nasal implant can be any of the nasal implants described herein. The nasal implant can be within the needle or provided separately from the delivery tool. The systems can also include one or more of any of the nasal implant guides that are also described herein.

<FIG> shows the underlying structural anatomy and tissues of a face. The outer layers of overlying skin and muscle have been removed in the figure to better show the underlying cartilage and bone that provide structure. The nose sits in the middle of the face and provides olfaction (smelling) and respiration control (e.g., by restricting the flow of air). The nose has two airflow pathways, one on each side of the nose (starting with each nostril) which combine to form a single airflow pathway into the body. Air from the nose flows through the trachea and into the lungs where the air is spread out in the lobules of the lungs and oxygen is absorbed for use by the entire body. Each of the two airflow pathways in the nose have several segments including two types of nasal valves (called external nasal valves and internal nasal valves) along each nasal airflow pathway that act to control airflow through the nose. Together, the external and internal valves control airflow into and out of the body. The valves are tissues that surround the airflow, and the amount of resistance they provide to the airflow is determined largely by their shape and size (e.g., their internal cross-sectional area). The internal nasal valve on each pathway is the narrowest segment of the pathway in the nose and generally creates most of the resistance. Besides the important function of controlling airflow, the internal nasal valves also help give the nose its distinctive shape. The nasal valves are shaped and supported by various structures in the nose and face, with upper lateral cartilage playing a significant role in the form and function of the valves. Further, large or small changes in internal nasal valve structure can impair nasal breathing and/or can change the cosmetic appearance of the nose. Such changes generally act to reduce the cross-sectional area of the internal valve and can be caused by surgery, medical treatment, or trauma to the face. Additionally, there are variations of nasal valve structure between individuals, with some individuals having significantly narrowed valves due to weakened or misshaped cartilage, commonly observed as a pinched nose. A narrowed valve region can increase the acceleration of airflow and simultaneously decrease intraluminal pressure, causing the valves to collapse. While even normal nasal valves can collapse under great respiratory pressures, dysfunctional internal valves can collapse during normal breathing, resulting in reduced oxygen flow, snoring, and/or mouth breathing.

The nose includes the external nose that protrudes from the face and a nasal cavity underneath the external nose. From top to bottom, the external nose has a root, a bridge, a dorsum (ridge), a free tip (apex), and a columella. The external nose is appended to the piriform aperture, the continuous free edges of the pear shaped opening of the nasal cavity in the skull and is formed by the nasal bones and the maxilla. As shown in <FIG>, the nose sits in the middle of the face, framed by the bones of the head, with frontal bone <NUM> superior to the nose, lateral maxilla frontal process <NUM> lateral to it, and the maxilla anterior nasal spine <NUM> inferior to it (another lateral maxilla frontal process on the other side of the nose is not visible in this view). The external nose can be roughly divided into three layers from outside to inside: an overlying skin and muscle layer (removed in this view), a middle cartilage and bony framework layer, and an inner mucosal layer (not readily visible in this view).

While the middle cartilage and bony framework layer provides form, structure, and support to the nose, it also allows the nose to be flexible and wiggle and bend in different directions. The middle cartilage and bony framework layer can be roughly divided into three sections, including from top to bottom: an upper (superior) bony third and middle and lower (inferior) cartilaginous thirds. The upper third includes paired left nasal bone 4a and right nasal bone 4b that are joined in the middle of the nose and form the top (or superior) part of the bridge of the nose. Nasal bone 4a (along with lateral maxilla frontal process <NUM>) joins frontal bone <NUM> superiorly to form the nasofrontal (nasion) suture line <NUM>. Laterally, nasal bone 4a joins the maxilla at its frontal process <NUM> to form a fibrous joint at the maxilla nasal bone suture line <NUM> (or nasomaxillary suture line). The middle third of the cartilage and bony framework layer includes septal cartilage <NUM>, which forms part of the septum of the nose and internally separates the nostrils and the two airflow pathways. Lateral process <NUM> of septal cartilage <NUM> merges superiorly with upper lateral cartilage <NUM> (another lateral process on the other side of the nose that merges with upper lateral cartilage on the other side of the nose is not visible in this view). <FIG> also shows minor alar cartilage <NUM>, one of several accessory cartilages which provide support and allow movement of the nose, and which impact the complex <NUM>-dimensional shape of the nose. Upper lateral cartilage <NUM> is normally fairly stiff and it has much of the responsibility for supporting the side of the nose. In conjunction with septal cartilage tissue, it helps to form the internal nasal valve, which is inside the nose under the upper lateral cartilage and not readily visible in this view.

As mentioned above, there are two internal nasal valves (one on either side of the nose). Each internal nasal valve is formed by and bordered medially by septal cartilage <NUM>, laterally by the caudal margin <NUM> of the upper lateral cartilage, and inferiorly by the head of inferior turbinate (not visible in this view). The attachment of the upper lateral cartilage to the septum (septal cartilage) forms an angle that defines the internal nasal valve angle (also called simply "valve angle"). The internal nasal valve angle is the narrowest part of the nasal airway and creates resistance that controls airflow through it. There is some natural variation between individuals in their nasal valve angles, and valve angles may change over time as a natural consequence of aging. Valve angle is determined in part by genetics, and an ethnic group has a particular average valve angle associated with it. There is also variation in valve angles between individuals, even within a particular ethnic group, and between an individual's left and right valves. Nasal valve angles may also be altered as a result of surgery, trauma or another intervention. A valve with a valve angle of less than about <NUM> degrees may generally be considered collapsed, causing nasal airway obstruction with nasal sidewall collapse upon inspiration and may merit treatment such as described herein. A valve angle that is greater <NUM> degrees may also cause some airway obstruction and/or cosmetic concern and may also merit treatment but its dysfunction is generally not as severe as a collapsed valve. Valves in need of treatment may be candidates for treatment using the implants, devices, systems and methods described herein.

The lower third of the cartilage and bony framework layer includes major alar cartilage (also referred to as lower lateral cartilage or inferior lateral cartilage, based on its location and to distinguish it from upper lateral cartilage) that help shape the nostrils and the tip of the nose. This cartilage is softer and more mobile than upper lateral cartilage, and it allows the tip of the nose to move. Major alar cartilage <NUM> is u-shaped and includes lateral crus <NUM> and medial crus <NUM>. Major alar cartilage <NUM> forms part of external valve around nostril <NUM> (also called nares), though it does not quite reach the bone laterally. The lower third of the cartilage and bony framework layer also includes alar fibrofatty tissue <NUM> of alar that fills the gap between lateral crus <NUM> and the bone. <FIG> also shows small accessory alar cartilage <NUM> that links the major alar and lateral cartilage <NUM> of the cartilage and bony framework layer.

As mentioned above, the nose is a complex, <NUM>-dimensional structure. It may be desirable to change its shape or better support its structure in order to improve or maintain its function or appearance (cosmesis), but it can difficult to change one aspect of the nose without adversely affecting another part. Indeed, previous surgical interventions are one cause of altered nasal valve function that may be treated using the systems and methods described herein. Described herein are implants, devices, systems and methods function for changing or supporting an aspect of a body structure or shape, including of the nose.

An exemplary nasal implant <NUM> (e.g., for use with a delivery tool as described herein) is shown in <FIG>. The implant <NUM> includes a central body having a first arm 76a and a second arm 76b each having respectively, first arm outer bevel 78a and second arm outer bevel 78b, on radially outward surfaces of a distal end of implant <NUM>. The outer bevels 78a,b may be useful, for example, for guiding an implant into a delivery device, for contracting an implant into a contracted configuration, for orienting an implant in a delivery device, or for guiding an implant through a delivery device. The first and second arms 76a,b can additionally include inner bevels 80a,b. In some embodiments, the inner bevels 80a,b and outer bevels 78a,b can form a double bevel. The inner bevels 80a,b and outer bevels 78a,b can share an edge (e.g., the two slanted surfaces can meet each other at any angle but <NUM>°) or may flare away from each other. In some examples, the inner bevels 80a,b and outer bevels 78a,b can meet another at any angle but <NUM>° and not share an edge (e.g., the bevels can be formed from different edges). The bevels 78a,b and 80a,b may be at an end of an arm or protrusion or along a side of a projection or protrusion.

The implant <NUM> can further include a proximal feature <NUM> at the proximal end. The proximal feature <NUM> can be a rounded atraumatic blunt end (as shown), a sharp end, or a flat end The atraumatic proximal feature <NUM> may prevent the proximal implant end from damaging, cutting, or exiting a tissue when it is in place in the tissue, such as in a nasal tissue. The proximal feature <NUM> may help to anchor or otherwise hold an implant in place in the tissue in which it is implanted.

The implant <NUM> can also include strain relief section <NUM> just distal to the proximal feature <NUM>. As shown, the strain relief section <NUM> can have a relatively smaller cross-sectional area (e.g., a diameter) than other portions of the implant <NUM>. In some embodiments, the strain relief section <NUM> may be larger than another area, but still provide strain relief by having a different configuration or a different material.

The implant <NUM> can also include a central bridging region <NUM> between the distal arms 76a,b and the proximal feature <NUM>. The central bridging region <NUM> can be especially useful for bridging an area in need of support, such as weak or collapsed area between structures on either (both) ends. For example, the central bridging region <NUM> may bridge a weak or collapsed nasal valve in a nose. The central region <NUM> may include one or more ribs (also called ridges) <NUM>. The ribs <NUM> can help anchor the implant <NUM> in place, such as by catching tissue against the ribs <NUM> or valleys therebetween. As shown in <FIG>, a first rib <NUM> has a first rib width W1 and a second rib <NUM> has a second rib width W2. Rib widths W1 and W2 may be the same size or may be different sizes. The first rib <NUM> may have a first rib diameter and the second rib <NUM> may have a second rib diameter. The first and second rib diameters may be the same size or may be different sizes. The implant <NUM> can additionally include one more other body features, such as bevels, scallops, or wings.

Implants similar to implant <NUM> are described in <CIT>.

<FIG> illustrates another embodiment of a nasal implant <NUM>. The implant <NUM> includes a central body <NUM>, a distal end <NUM> with two forked arms <NUM>, <NUM>, and an atraumatic proximal end <NUM>. The implant <NUM> includes two barbs <NUM> at the portion of the implant where the arms <NUM>, <NUM> meet the central body <NUM>. The barbs <NUM> extend transversely to the plane defined by the forked arms <NUM>, <NUM>. The barbs <NUM> extend from two opposing sides of the implant and can be molded or skived. Additionally, the central body <NUM> can include a series of ribs <NUM> therearound. Implants similar to implant <NUM> are described in International Application No. <CIT>, titled "NASAL IMPLANTS AND METHODS OF USE".

<FIG> show front and side views, respectively, of an implant <NUM> (which can be, for example, the same as implant <NUM> or implant <NUM>) implanted in a patient's nose (e.g., with delivery tools as described herein) and supporting a tissue section of a patient's nose. The implant <NUM> may be useful for maintaining or improving nasal function or appearance and can underlie the skin and muscles (which have been removed in the figures to better illustrate the implant and the underlying nasal structures and implant). <FIG> show the implant <NUM> in place for supporting or changing an internal nasal valve. The implant <NUM> thus apposes structures in the cartilage and bony framework layer under the skin and muscle. The implant <NUM> has a body with a proximal end <NUM>, a distal end <NUM>, and a central portion <NUM> between the proximal and distal ends. The central portion <NUM> is in a position between the nasal cartilage and patient skin or muscle. The central portion <NUM> further apposes upper lateral cartilage <NUM> and lower lateral crura <NUM> of the lower lateral cartilage <NUM>. As mentioned above, along with the septal cartilage, the caudal end of the upper lateral cartilage defines the internal valve angle, and central portion <NUM> of implant <NUM> also apposes the caudal end <NUM> of the upper lateral cartilage <NUM> and so overlies or acts on the internal valve wall, providing support to or changing a shape of the internal valve. The distal end <NUM> of implant <NUM> apposes structures in the upper part of cartilage and bony framework. The arms <NUM>, <NUM> appose nasal bone <NUM>, frontal process <NUM> of the maxilla bone, and maxilla nasal bone suture line <NUM>(nasomaxillary suture line). In some variations, a distal end of an implant may be apposed or in proximity to one of more structures in the upper layer or any of the structures or tissues in the middle or lower cartilage and bony framework layer (e.g., accessory cartilage, major alar cartilage, minor alar cartilage, septal cartilage, maxilla, etc.).

In some embodiments, specialized tools can be used to deliver the implants (e.g., implants <NUM>, <NUM>, <NUM>) into the nasal tissue.

Referring to <FIG>, a delivery tool <NUM> can be used to deliver implant <NUM> (which can be any of the implants described herein). The delivery tool <NUM> includes a hand graspable handle <NUM>, a needle <NUM> extending from the handle <NUM>, and a plunger <NUM> attached to a push rod <NUM> and adapted to advance the nasal implant <NUM> within the needle <NUM>. In some embodiments, the needle <NUM> can include a non-circular cross-section that can allow the implant to align properly within the needle <NUM> (e.g., the arms of the implant can diverge slightly in the outward direction of the major axis to orient the implant <NUM> within the needle <NUM>). Further, handle <NUM> can include implant orientation features <NUM>. When the implant <NUM> is properly positioned within the needle <NUM>, the implant orientation features <NUM> can be oriented along the same longitudinal axis as the arms or forks of the implant <NUM> when the arms are in the expanded configuration. The orientation features <NUM> can thus help the user visualize the plane defined by the arms of the implant <NUM> in the expanded configuration. In some embodiments, the handle <NUM> can include an implant loading window <NUM> that allows viewing of the implant <NUM> through the handle <NUM> when the device <NUM> is in the primed (ready) position. Additionally, in some embodiments, the delivery tool <NUM> can include a plunger o-ring therein that can be configured to provide low, consistent friction throughout the deployment of the plunger <NUM> (i.e., to keep the deployment smooth) and to help keep the plunger <NUM> from moving unintentionally if the tool <NUM> is moved.

<FIG> show the stages of the proper deployment of the implant <NUM> from the tool <NUM>. During Phase <NUM> of the deployment (<FIG>), the force the user applies to the plunger <NUM> (FPRESS) can correspond to a force that overcomes the minimal friction of the implant <NUM> sliding within the needle <NUM> (FIMPLANT) and the friction of the push rod <NUM> within the tool <NUM>, i.e., along the O-ring (FO-RING). The plunger force can be low and constant as the implant <NUM> starts to exit the needle <NUM> and interact with the nasal tissue. During Phase <NUM> of the deployment (<FIG>), the forked arms of the implant <NUM> begin to exit the distal end of the needle <NUM> and interact with the adjacent nasal tissue. This generates a force (FPIERCE) that translates straight to the plunger <NUM>. As a result, FPRESS becomes greater until the forks of the implant <NUM> pierce into the tissue. During Phase <NUM> (<FIG>), when deployed correctly, the user continues to depress the plunger <NUM> at the higher force (FPRESS) until the plunger <NUM> reaches its end of travel, e.g., until the plunger <NUM> hits the proximal end of the handle <NUM>. In some embodiments, the tool <NUM> can be held stationary relative to the tissue while the forked arms of the implant <NUM> pierce into the tissue about <NUM> beyond the distal tip of the needle <NUM>.

<FIG> shows improper deployment of the implant <NUM> from the tool <NUM>. In order to provide counter traction while applying FPRESS, users sometimes support the device <NUM> by grabbing the housing of the tool e.g. the main handle body <NUM>. Supporting the device <NUM> here can have a force reaction FGRIP as the user attempts to counteract the force FPRESS by pulling proximally on the handle <NUM>. As a result, the implant <NUM> can be held stationary while the tool <NUM> is retracted proximally from the tissue. This can result in the implant <NUM> not reaching its desired or intended position and potentially about <NUM>-<NUM> caudal to (delivered short of) the desired location. To the untrained eye, this reaction may not even be detected during the deployment and can feel just like a correct deployment. However, this incorrect placement can require removal of the implant <NUM> or result in the implant <NUM> not properly supporting the nasal tissue in the desired manner. Thus, in some embodiments, a delivery tool can be configured to prevent or minimize the chance of inadvertent retraction during deployment.

<FIG> illustrate an embodiment of a delivery tool <NUM> that can help prevent or minimize the chance of inadvertent retraction during deployment. The delivery tool <NUM> includes a hand graspable outer handle <NUM>, an inner handle <NUM>, and a needle <NUM> (e.g., with a portion having a non-circular cross-section as described with respect to delivery tool <NUM>). The outer handle <NUM> is slideable relative to the inner handle <NUM> and includes a distal button 204a and a proximal button 204b. The inner handle <NUM> has a flange <NUM> and the distal end thereof, orientation features <NUM>, and an implant loading window in some embodiments. As shown in <FIG>, bearing surfaces 238a-d on the inner handle <NUM> can slide along rails 222a-d on the inner surface of the outer handle <NUM> to allow the sliding motion between the inner handle <NUM> and the outer handle <NUM>. The rails 222a-d can span <NUM>-<NUM>%, such as approximately <NUM>%, of the length of the outer handle <NUM> while the bearing surfaces 238a-d can span substantially the entire length of the inner handle <NUM>. Like tool <NUM>, the implant orientation features <NUM> of tool <NUM> can be positioned so as to align longitudinally with the arms of the implant <NUM> (which can be any implant described herein).

The nasal implant <NUM> can be advanced through the needle <NUM> by advancing the outer handle <NUM> distally relative to the needle <NUM>. The outer handle <NUM> is rigidly connected to a push rod <NUM> (see <FIG>), which provides force to the implant <NUM> to move it distally through the needle <NUM> when the outer handle <NUM> is moved distally over the inner handle <NUM>. The distal button 204a can be configured to be depressed to allow distal movement of the outer handle <NUM> relative to the inner handle <NUM>. Further, the proximal button 204b can be configured to be depressed to allow release of the outer handle <NUM> from the inner handle <NUM> such that the outer handle <NUM> can move proximally relative to the inner handle <NUM> to allow loading of the implant <NUM>.

<FIG> show the stages of deployment of the implant <NUM> with the tool <NUM>. At <FIG>, the implant <NUM> is loaded in the needle <NUM> and ready for deployment. No deployment of the implant <NUM> can occur until the user depresses the distal button 204a. At <FIG>, the tool <NUM> illustrates partial deployment of the implant <NUM>. The distal button 204a is in the depressed position, thus disengaging the inner handle <NUM> from the outer handle <NUM>. Similar to device <NUM>, the force to deploy the implant <NUM> will be low until the forked arms of the implant <NUM> begin to engage the tissue. At this point, the force to advance the outer handle <NUM> and implant <NUM> will increase until the forked arms pierce into the soft tissue. The deployed configuration of the delivery tool <NUM> with the implant <NUM> deployed in the tissue is shown in <FIG>. As the outer handle <NUM> slides forward relative to the inner handle <NUM>, the forked arms of the implant <NUM> will be pushed distally out of the needle <NUM> and into the tissue. When the outer handle <NUM> extends completely over the inner handle <NUM>, the outer handle <NUM> can come to a hard stop (i.e., against the flange <NUM>) and lock in the stopped position. When the outer handle <NUM> is fully advanced, the handle can lock in place with an audible and tactile click detectable by the user. If the outer handle <NUM> is not advanced fully to the hard stop and associated locking position, retracting the device <NUM> will result in sliding the outer handle <NUM> proximally, warning the user that full deployment of the nasal implant <NUM> was not achieved.

Advantageously, because the user holds only the outer handle <NUM> of the device <NUM> and not the inner handle <NUM>, the user will not place a counter load (i.e., FGRIP in <FIG>) on the inner handle <NUM> or needle <NUM>. As a result, the tool <NUM> is not retracted relative to the tissue during deployment. Also, because the user can use the outer handle <NUM> as both a grasping mechanism and the plunger, the user is less likely to change hand grip or orientation during use, thereby helping to ensure that the orientation of the tool <NUM> and thus the implant <NUM> remains consistent during deployment.

<FIG> show the delivery device <NUM> in a pre-loaded configuration (i.e., without an implant therein). The cross-sectional view in <FIG> shows the distal button 204a engaged with a latch <NUM> of the inner handle <NUM>, as the distal button 204a has not yet been depressed. Further, in this position, the proximal button 204b is also not depressed. A cantilevered portion 205b of the proximal button 204b can have spring-like properties to bias the button 204b in the upwards direction. This cantilevered portion 205b can be heat staked or bonded to the inner surface of the outer handle <NUM> distal to the button and supported by a rib feature <NUM> proximal to the proximal button. Further, a retraction stop tang <NUM> on the inner handle <NUM> can be engaged with a distal tooth <NUM> on the outer handle <NUM>. This engagement can prevent the outer handle <NUM> from retracting proximally relative to the inner handle <NUM> in the pre-loaded configuration. Referring to <FIG>, to load an implant into the device <NUM>, the proximal button 204b can be depressed to push the retraction stop tang <NUM> away from the distal tooth <NUM>. As the proximal button 204b is held down, the outer handle <NUM> can be retracted proximally relative to the inner handle <NUM> and proximally past the distal tooth <NUM> and the proximal tooth <NUM> to allow for loading of the implant.

<FIG> show the delivery tool <NUM> in a loading configuration ready for loading of an implant. The outer handle <NUM> has been retracted proximally relative to the inner handle <NUM> to expose an implant loading chamber <NUM>. In the retracted position, the retraction stop tang <NUM> of the inner handle <NUM> can hit a stop tooth <NUM> and simultaneously the tang latches 220a (connected to the stop tang <NUM>) can hit the stop rib 220b to prevent the inner handle <NUM> and outer handle <NUM> from becoming completely separated. Retraction of the outer handle <NUM> exposes the implant loading chamber <NUM> and fully pulls the internal push rod <NUM> proximally such that it is clear of the implant loading chamber <NUM> and the implant can be loaded. In one embodiment the delivery tool can be configured such that while the loading configuration, the distal button 204a can be prevented from being depressed (i.e., to prevent accidental deployment of the implant while moving the device into the ready configuration). As shown in <FIG>, in the loading configuration, a t-slot feature <NUM> on the inner surface of the latch <NUM> can ride along a rail <NUM> on the inner handle <NUM>, thereby preventing the distal button 204a from being pushed downwards. The rail <NUM> can extend from only part way along the length of the inner handle <NUM> (e.g., <NUM>-<NUM>%, such as <NUM>%) and can end right at position of the t-slot feature <NUM> in the primed or pre-loaded configuration (thereby allowing the t-slot feature <NUM> to disengaged and move the button 204a back up into position).

After loading the nasal implant into the loading chamber <NUM>, the outer handle <NUM> can be slid distally until it reaches the ready position hard stop <NUM> on the inner handle <NUM> shown in <FIG>. This positions the device <NUM> back in the primed configuration shown in <FIG>. In this position, the t-slot feature <NUM> is disengaged from the rail <NUM> on the inner handle <NUM> with the distal button 204a, remaining in a non-depressed position. In this position, the deployment button is free to be depressed when ready for deployment. In the primed position,.

A user (e.g., physician) can then use the delivery tool to deliver the nasal implant to the targeted nasal tissue. The user can thus insert the needle <NUM> of delivery tool <NUM> (with the implant therein) in the primed configuration into the nasal wall of the patient. While the user is navigating the nasal wall anatomy, the device <NUM> can experience both tensile and compressive loads due to friction and resistance of the target tissue, but the handles <NUM>, <NUM> will not move relative to one another.

Referring to <FIG>, once the user has positioned the device <NUM> in the appropriate position in the body and is ready to deploy the implant, the distal button 204a can be depressed. Upon pressing the distal button 204a, the button 204a will push the latch <NUM> downwards (i.e., into the clearance space <NUM>), causing it to catch under the lip <NUM> of the outer handle <NUM> (as shown in the change from <FIG>). In some embodiments, this activation can create an audible and/or tactile feedback mechanism to provide indication to the user that the implant is ready to be deployed (i.e., that the deployment lock has been released). Once latched, the user can release the distal button 204a (though release of the button is not required), as the distal button 204a will remain depressed (due to the latch <NUM> being caught on the lip <NUM>). After pressing the distal button 204a, the user can slide the outer handle <NUM> forward (as the latch <NUM> is no longer engaged with the lip <NUM> on the inner handle <NUM>), as shown in the change from <FIG>. As the outer handle <NUM> moves forward, the push rod <NUM> moves distally to push the implant from the loading chamber <NUM> and deploy the implant. As shown in <FIG>, the user can advance the outer handle <NUM> forward until the outer handle <NUM> reaches a hard stop against the flange <NUM>.

As shown in <FIG>, once the outer handle <NUM> has reached the hard stop against the flange <NUM>, the handle <NUM> can lock into place to allow retraction of the device <NUM>. Referring to <FIG>, in this position, the retraction stop tang <NUM> can move proximal to the proximal stop tooth <NUM> such that the tang <NUM> rests against the proximal tooth <NUM>, thus preventing the outer handle <NUM> from moving proximally relative to the inner handle <NUM>. This lock allows for the physician to retract the device <NUM> from the soft tissue without unsheathing the outer handle <NUM> from the inner handle <NUM>. This latching action can create an audible and/or tactile feedback mechanism to provide indication that the implant has been fully deployed or fully released and that the device is latched in the deployment position (i.e., prior to full release, the outer handle <NUM> can be moved proximally relative to the inner handle <NUM> thus indicating that the implant has not been properly or fully released).

After delivering the nasal implant, the device <NUM> can be reloaded with another implant by pushing the button 204a as described above with respect to <FIG>. Further, referring to <FIG>, as the outer handle <NUM> is pulled proximally, the deployment button 204a engages with the proximal edge of the implant loading chamber <NUM> which pushes latch <NUM> out of engagement with the lip <NUM>, allowing the latch <NUM> and the button 204a to spring upwards (e.g., the button 204a and/or latch <NUM> can be spring biased towards the upwards position to cause the button 204a to move upwards as shown in the change from <FIG>).

Referring to <FIG>, the tip of needle (e.g., the needle <NUM> of device <NUM>) can be used to facilitate penetration of tissue and/or tissue separation during positioning of the delivery needle <NUM> for delivery of the nasal implant <NUM>. For example, referring to <FIG>, a tip 996a can have a tri-bevel faceted configuration that includes three distinct surfaces 997a-c, each of which is beveled (i.e., beveled at <NUM> degrees from the primary bevel orthogonal plane). Further, the tip 996a can have a primary angle α that varies from about <NUM>-<NUM> degrees. As another example, referring to <FIG>, a tip 996b can have a flat bevel design without a faceted tip. The tip 996b can have a primary angle α of between <NUM>-<NUM> degrees. The flat beveled tip 996b can have less of a cutting tip (e.g., than tip 996a) that can enable one or more of the following: tissue layer differentiation for improved plane detection (i.e. Dermis, Upper and Lower Lateral Cartilages, Mucosa), differentiation between forces encountered in the different tissue types, and a reduction in cannula travel vector bias to improve soft tissue plane dissection. Referring to <FIG>, a tip 996c can have two beveled surfaces 999a,b (e.g. beveled at <NUM> degrees) that meet in a sharp pointed end <NUM>. The tip 996c can have a can have a primary angle α of between <NUM>-<NUM> degrees. The beveled configuration of tips 996a, 996b, and 996c can facilitate easier access to the mid-thickness plane of the nasal valve wall. The beveled design of tips 996a, 996b, and 996c can also result in a heightened resistance to cephalic travel when positioned over the maxilla for implant deployment. The bevel grind angles can balance strength of the tip geometry, tip sharpness, and affects the interaction of the implant arms (forks) during soft tissue engagement.

A number of alternatives can be used in the delivery tools described herein, such as for the buttons on the handle and hard stops and locking structures in the inner handle portion of the delivery tool.

In some embodiments, a button with a magnetic latching design can be used. <FIG> illustrate a portion of a handle of an exemplary delivery tool <NUM>. The delivery tool <NUM> is similar to delivery tool <NUM> except that the distal button 304a can be attached to a latch <NUM> that attaches to a magnetic stop <NUM> when depressed. The button 304a can include a living spring <NUM> that biases the button 304a upwards. When depressed (as shown in the change from <FIG>), the button 304a can push on the latch <NUM>, which pivots about pivot point <NUM>. A magnet <NUM> on the underside of the latch <NUM> can be attracted to the magnetic stop <NUM>. The latch <NUM> can thus be moved out of the way to allow for deployment, as described for delivery tool <NUM>. As shown in <FIG>, when the outer handle <NUM> is retracted, the proximal edge <NUM> of the implant loading port <NUM> can interact with a reset ramp boss <NUM> to pull the magnet <NUM> up and off of the stop <NUM>, causing the button 304a to spring back upwards.

In some embodiments, a spring can be used in one or more of the locking mechanisms of the delivery tool. <FIG> illustrate a delivery tool <NUM> that is similar to device <NUM> except that it includes a spring locking mechanism that can engage with and reset the distal button 404a. A spring <NUM> (such as a leaf spring) biases the button 404a in the upwards position. The spring <NUM> thus flattens as the button 404a is depressed (as shown in the change from <FIG>). In this embodiment, the button 404a is held in the depressed state by the user during deployment rather than latching in the depressed state. During the proximal retraction, the distal button 404a is reset with the spring <NUM>.

In some embodiments, the button and latch can be combined on the external portion of the delivery device. For example, <FIG> show a device <NUM> that is similar to device <NUM> except that the distal button 504a can be a spring-loaded latch with a central pivot point <NUM>. A small spring (e.g., a die stamped spring) can bias the button 504a in the up position. During deployment, the user can hold the button 504a down. The latch can be configured to be positioned in a primed position (<FIG>) or a deployed position (<FIG>). From the primed position, the user can press and hold the distal (raised) portion) the lever <NUM> to release it from its proximal locked position <NUM> on the inner handle <NUM>. The outer handle <NUM> can then be moved distally until the lever <NUM> reaches the locked position <NUM> on the inner handle <NUM> (as shown in <FIG>). In this position, the implant can be deployed.

In some embodiments, a button with a spring and snap-in detent can be used. <FIG> illustrate a delivery device <NUM> that is similar to device <NUM> except that the distal button 604a includes a spring and snap-in detent insert. <FIG> shows the device <NUM> in the primed position. In this position, the distal button 604a is in the "up" position and the button latch <NUM> is also in the "up" position abutted to the hard stop <NUM> on the inner handle. In the prime configuration, a spring <NUM> holds up the button latch <NUM> and, similar to device <NUM>, a retraction stop tang can be locked to prevent retraction of the outer handle <NUM> relative to the inner handle <NUM>. <FIG> shows that as the button 604a is depressed, the button latch <NUM> is forced downward against the spring <NUM>, compressing the spring <NUM> and clearing the button latch <NUM> from the hard stop <NUM> on the inner handle <NUM>. In some embodiments, the button 604a can emit a click sound and/or provide a tactile response. Exemplary mechanisms that can generate the click and retain the button from springing back upwards following release is detailed in <FIG>, described further below. The outer handle <NUM> can then be advanced distally over the handle <NUM> for deployment of the implant. <FIG> shows the final deployment state of the device <NUM>. The outer handle <NUM> bottoms out on the flange <NUM> of the inner handle <NUM>. In this position, the retraction stop tang on the inner handle springs into a second lock position on the proximal end of the outer handle, as described above with respect to device <NUM>. <FIG> shows the button 604a reset mechanism. To reload the device, the user holds down the retraction button as described above with respect to tool <NUM>. While retracting the outer handle <NUM> relative to the inner handle <NUM>, a loading port ramp <NUM> is designed to engage with the central rib <NUM> on the deployment button 604a. The ramped design of these two features <NUM>, <NUM> pushes up on the distal button 604a to overcome the detent holding it down (as described with respect to <FIG> below) and the deployment button 604a and button latch <NUM> spring upwards.

As shown in <FIG>, one exemplary embodiment, the button 604a can include bilateral connective linkages that engage with discrete positions on bilateral button detent inserts. <FIG> shows exemplary cross-sections of the device <NUM> through the button 604a when the button 604a is in the primed (up) position. In this position, detent bumps 663a,b on the deployment button arms 669a,b can be positioned within first reliefs 664a,b on detent insert tabs 667a,b to prevent any component preloads during shelf life. Referring to <FIG>, when the button 604a is depressed, the detent bumps 663a,b on the deployment button arms 669a,b can force the cantilever arms 661a,b on the detent insert tabs 667a,b to deflect out of the way (shown by the arrows in <FIG>) and snap back into position once the detent bumps reach a second relief 665a,b location. By snapping back into position, an audible click and/or tactile response can occur, and the detent insert tabs 667a,b can retain the button 604a in the down/depressed position.

<FIG> show another exemplary embodiment in which the button 604a includes bilateral connection linkages that engage with discrete positions on bilateral button detent inserts. The embodiment is similar to the embodiment of <FIG> except that the detent bumps 1463a,b on the arms 1469a,b are ramped to decrease the required force to depress the button. Additionally, the reliefs 1464a,b and 1465a,b have dome shapes to provide for stronger holding. Further, the detent insert tabs 1467a,b can each have a semi-circular or D shape, where the straight edge of the D deflects outwards during deployment (as shown by the arrows in <FIG>). Similar to the embodiment of <FIG>, the detent bumps 1463a,b can move from the higher reliefs 1464a,b to the lower reliefs 1465a,b when transitioning from the primed (<FIG>) to the deployed (<FIG>) configuration. The lower detents 1465a,b can hold the button 604a,b in the down/depressed configuration until it is reset during loading.

The delivery tools described herein can include a number of advantages. For example, the beveled needle tips can allow for tissue plane differentiation for dissecting tissue instead of piercing tissue. The blunter tip of the single bevel cannula can be less likely to penetrate through tissue layers than a sharper distal tip like a cutting trocar beveled tip, can promote easier detection of the intended dissection plane, and can minimize mid-deployment advancement. For example, in the final deployment position over the maxilla, a blunter tip will be less likely than a sharper tip to advance cephalically during deployment of the implant.

The delivery tools described herein also offer improved ergonomics for the user. Minimal or no counter traction needs to be applied on the device due to the deployment mechanics with the outer handle being used for implant advancement. The use of the outer handle to actuate the plunger also reduces the potential for needle withdrawal from the tissue during implant deployment and inadvertently moving the nasal implant from the desired implant location and orientation.

The delivery tool described herein also allow for improved single handed device operation. The delivery tools described herein enable use of the device with minimal manipulation of the tool used to deploy the implant. While holding the device by the grip, the physician can position the needle at the desired location in the soft tissue. Once ready for deployment, the user can readily reach and depress the distal button (e.g. deployment actuator button) with minimal to no manipulation of their hand grip followed by sliding forward the outer handle as gripped to push the nasal implant through the needle to deploy the implant in the targeted location. The one-handed use is beneficial because it helps avoid rotation and deflection of the delivery device during use.

Further, actuation and retraction locks in the devices described herein can be designed to prevent premature deployment. Shrouds around the buttons can likewise be used to prevent inadvertent deployment of the device during use.

It is to be understood that any feature(s) described herein with respect to one embodiment can be combined with or substituted for any feature(s) described herein with respect to another embodiment.

The delivery tools described herein can alternatively or additionally include features that are described in<CIT>, titled "NASAL IMPLANTS AND SYSTEMS AND METHOD OF USE".

In some embodiments, a nasal implant positioning guide can be used when delivering a nasal implant with any of the delivery tools described herein.

<FIG> illustrate external guides that can be used for planning the location and orientation of the implant relative to the nasal anatomy. The nasal implant guides <NUM> can each include a handle <NUM> and a nasal implant guide portion <NUM> (e.g., having an image of a nasal implant on one or both sides thereof to indicate the direction of deployment). The nasal implant guides <NUM> can further each include a proximal opening <NUM> and a distal opening <NUM>. The nasal implant guides <NUM> can include a forked feature <NUM> projecting distally from the distal opening <NUM>. In some embodiments, the nasal implant guides <NUM> can further include a plurality of markings <NUM> (e.g., six small bosses thereon) adjacent the proximal opening <NUM> adapted to provide a ruler for a user to judge a distance between the proximal feature and an alar rim edge. These markings <NUM> can start <NUM> from the center of the ball end, which corresponds with the proximal opening <NUM>, and can be spaced <NUM> apart. In some embodiments, the handle <NUM> can be engaged and axially aligned with the nasal implant guide portion <NUM>. In other embodiments, the handle <NUM> can be engaged with the nasal implant guide portion <NUM> such that the handle <NUM> forms about a <NUM> degree angle to a dominant axis of the nasal implant guide portion <NUM>.

<FIG> shows an implant 1400a with the handle 1412a and implant guide portion 1410a axially aligned. <FIG> illustrates a guide 1400b with the handle 1412b at a <NUM> degree angle relative to the guide portion 1410b. The proximal opening 1402b and distal opening 1406b are further larger than the openings 1402a and 1406a to accommodate larger marking pen tips. The forked feature 408b of the aid guide 1410b is configured to contour with the shape of the implant forks to make the implant fork positioning clearer. No markings are shown in device 1400b. <FIG> shows a device 1400c with markings 1404c in the forms of bumps at <NUM>, <NUM>, and <NUM>. <FIG> includes markings 1404d in the forms of bumps at <NUM>, <NUM>, and <NUM>. <FIG> includes markings 1404e in the forms of cut ticks at <NUM>, <NUM>, and <NUM>.

The location of the handle <NUM> at a <NUM> degree angle relative to the guide portion <NUM> (as shown in <FIG>) can, in some instances, enable the user to hold the tool about the patient's face to promote better visibility of the target anatomy than when holding it in line with the intended trajectory. The <NUM>-degree design can allow users of left or right handedness to use the guide <NUM> while operating on either side of the nasal anatomy.

The nasal implant guides described herein can be used as a planning/marking aid and can be intended to mimic the implant and help the physician map out their preferred implant position. For example, as shown in <FIG>, the nasal implant guide <NUM> can be used to guide placement of the implant <NUM> (which can be any implant described herein). Like guide 1500a, guide <NUM> has a handle <NUM> that is axially aligned with the guide portion <NUM>. As shown in <FIG>, the guide <NUM> can be positioned such that the user can hold the handle <NUM> and make a mark (e.g., with a surgical pen) on the nasal lateral wall through the distal opening <NUM> to indicate the desired position of the distal end of the needle of the delivery tool (while the forked features <NUM> can correspond to the positioning of the distal forked arms 1676a,b of the implant <NUM>). Similarly, the user can make a mark on the nasal lateral wall through the proximal opening <NUM> to indicate the desired positioning of the proximal feature <NUM> of the implant <NUM>. The markings <NUM> can advantageously be used to act as a ruler to visualize the distance of the proximal feature <NUM> of the implant from the alar rim edge <NUM>. The length of the handle <NUM> can be designed to keep the user's hand out of the way to provide visualization of the guide <NUM> and anatomy during planning/marking.

As shown in <FIG>, the markings of the guide <NUM> can be used to position the nasal implant <NUM> within the nasal anatomy <NUM> such that the forked arms 1676a,b are positioned adjacent and across the maxilla bone and the central bridging region <NUM> is positioned to support and upper and lower lateral cartilage.

Referring to <FIG>, a nasal implant <NUM> can be similarly placed on the nasal anatomy <NUM> to help with positioning of the implant <NUM> within the nasal anatomy <NUM>.

Although the terms "first" and "second" may be used herein to describe various features/elements, these features/elements should not be limited by these terms, unless the context indicates otherwise.

For example, a numeric value may have a value that is +/- <NUM>% of the stated value (or range of values), +/- <NUM> % of the stated value (or range of values), +/- <NUM>% of the stated value (or range of values), +/- <NUM>% of the stated value (or range of values), +/- <NUM>% of the stated value (or range of values), etc. Any numerical range recited herein is intended to include all sub-ranges subsumed therein.

Claim 1:
A nasal implant delivery tool (<NUM>) comprising:
an inner handle (<NUM>) including a loading chamber (<NUM>) configured to receive a nasal implant (<NUM>);
an outer handle (<NUM>) configured to move axially relative to the inner handle between a plurality of discrete locking positions;
locking structures (<NUM>, <NUM>, <NUM>) configured to releasably lock the outer handle from moving relative to the inner handle at the discrete locking positions, including at a locking position preventing the outer handle from moving proximally relative to the inner handle;
a retraction button (204b) configured to be depressed to allow release of the locked outer handle from the inner handle such that the outer handle can move proximally relative to the inner handle to allow loading of the implant;
a needle (<NUM>) extending distally from the inner handle, the needle having a central lumen and a distal opening; and
a push rod (<NUM>) configured to move the nasal implant from the loading chamber, through the central lumen, and out the distal opening of the needle, wherein the push rod is coupled to the outer handle such that the push rod moves axially relative to the inner handle when the outer handle is moved axially relative to the inner handle.