Patent ID: 12256981

DETAILED DESCRIPTION OF THE INVENTION

FIG.1is an internal view of the nasal cavity showing the relevant nasal anatomy. Shown for orientation is the lateral nasal cavity wall4, the nose1, nostril2, and the upper lip3. The superior turbinate5, middle turbinate6, and inferior turbinate7are depicted along with the associated nerves relevant to this invention shown in dashed lines. The posterior nasal nerves10,11and12are responsible for the parasympathetic control of the nasal mucosa including turbinates. These posterior nasal nerves (PNNs) originate from the sphenopalatine ganglion. At times other accessory posterior nasal nerves (APNNs) may originate from the greater palatine nerve or from the bony plate underneath the mucosa.

FIG.2is a schematic illustration of surgical probe29, which is configured for cryo-ablation of posterior nasal nerve function for the treatment of rhinitis. Surgical probe29comprises: probe shaft20, with shaft distal end21and shaft proximal end27; surgical hand piece23, e.g., with pistol grip24, finger grip25, pistol trigger flow control valve actuator26, button flow control flow valve actuator22, finger grip barrel28, cryogen reservoir housing29; and distal end effector30(e.g., spring-like structure) with end effector proximal end31, and end effector distal end32. Surgical probe shaft20is between, e.g., approximately 1 mm and 4 mm in diameter and between, e.g., approximately 4 cm and 10 cm in length. Surgical probe shaft20may be fabricated from various biocompatible materials such as a surgical grade stainless steel hypodermic tube, or may alternatively be fabricated from a polymeric extrusion. Surgical probe shaft20comprises at least one liquid cryogen delivery channel between shaft distal end21and shaft proximal end27. Probe shaft20is substantially rigid in one variation, and may also be configured to be malleable and shape formable by the user. The distal end effector30is shown having, multiple variations described herein and may be optionally interchanged depending upon which particular embodiment is utilized by a practitioner.

Although probe shaft20is depicted to be straight, it is well within the scope of this invention probe shaft20may be manufactured with at least one curved segment. Surgical hand piece23is disposed on the proximal end22of probe shaft20. Surgical hand piece23comprises a liquid cryogen reservoir, not shown, that may be conventionally supplied with liquid cryogen and configured for a single patient use. Alternatively, surgical hand piece23may be configured for use with a user replaceable liquid cryogen reservoir in the form of a cartridge. Liquid cryogen cartridges are readily commercially available from many sources. In yet another alternative, a reservoir separate from the device may be fluidly coupled to the hand piece23. Surgical hand piece23may further comprise a liquid cryogen flow control valve, not shown, that may be disposed in fluidic communication with the liquid cryogen reservoir and the liquid cryogen channel in probe shaft20.

Surgical device29may be configured to be held like a pistol by the surgeon or practitioner using pistol grip24, or the surgeon or practitioner may hold surgical device29like a writing utensil using finger grips25, with finger grip barrel28residing between the thumb and index finger of the surgeon. Surgical device29may be configured with, e.g., two or more liquid cryogen flow control valve actuators comprising pistol trigger liquid cryogen flow control actuator26, which may be used to control the flow of liquid cryogen when the surgeon holds surgical device29using pistol grip24. Liquid cryogen flow control actuator button22may be used to control the flow of liquid cryogen when the surgeon holds surgical device29by finger grips25. Probe shaft20may be configured to be rotatably coupled to the surgical device29to facilitate positioning of distal end effector30(e.g., spring-like structure) without having to rotate the surgical device29excessively. Distal end effector30(e.g., spring-like structure), with end effector proximal end31, and end effector distal end32is disposed on the distal end21of probe shaft20as shown. Distal end effector30(e.g., spring-like structure) is configured as a liquid cryogen evaporator, and is configured to be pressed against the lateral nasal wall within the cul-de-sac described above for cryo-ablation of at least one posterior nasal nerve. The construction and the function of distal end effector30(e.g., spring-like structure), and alternative embodiments are described in detail below.

Surgical device29may be configured as a simple mechanical device that is void of electronics as shown. Alternatively, surgical device29may be configured with at least one electronic function. In one embodiment, a temperature sensor may be disposed in the vicinity of distal end effector30(e.g., spring-like structure) and used to measure, display, or control a temperature of surgical interest. A temperature sensor may be configured to sense the temperature of evaporating cryogen within distal end effector30(e.g., spring-like structure). A temperature sensor may also be configured to sense the temperature of a tissue of surgical interest. The liquid cryogen control valve22may also optionally comprise a servo mechanism configured to respond to a sensed temperature to modulate the flow of cryogen in order to control a desired surgical parameter.

In addition to a temperature sensing capability, surgical device29may be configured with a camera and/or a light source disposed in the vicinity of distal end21of probe shaft20. The camera and light source may be used, e.g., to identify nasal anatomical landmarks, and may be used to guide the placement of distal end effector30(e.g., spring-like structure) against the lateral nasal wall for a cryo-ablation of the function of a target posterior nasal nerve. An ultrasonic or optical doppler flow sensor may also be disposed in the vicinity of distal end21of probe shaft20and be used, e.g., to locate the major artery associated with the target posterior nasal nerve, as a means for locating the target posterior nasal nerve. In addition, one or more electrodes may be disposed in the vicinity of distal end21of probe shaft20, which may be used for electrical stimulation or electrical blockade of the function of a target posterior nasal nerve using the observed physiological response to the stimulation or blockade to confirm correct surgical positioning of distal end effector30(e.g., spring-like structure) prior to a cryo-ablation and/or to confirm effectiveness of a cryo-ablation by the determination of a change in the physiological response from before and after a cryo-ablation.

Any number of temperature sensing, endoscopic instruments, servo controlled cryogen control valves, ultrasonic or optical doppler flow detection, and/or electrical nervous stimulation and blockade mechanisms may be optionally incorporated into the devices described herein. Also: providing a surgical probe as described here with a liquid cryogen reservoir that is external to the probe hand piece is also within the scope of this invention.

FIG.3Ais a schematic illustration of an alternative end effector embodiment, which comprises spring-like structure39which is configured in a coaxial arrangement with probe shaft20.FIG.3Bis a schematic illustration of the distal end of an alternative embodiment surgical probe43which comprises spring-like structure44, which is configured with a lateral curve as shown with proximal end46in a tangential relationship with the distal end21of probe shaft20.FIG.3Cis a schematic illustration of the distal end of an alternative embodiment surgical probe48, with spring-like structure49configured as a loop structure as shown, with both ends of spring-like structure49in a substantially tangential relationship with distal end21of probe shaft20. The three alternate spring-like structure embodiments39,44, and49depicted inFIGS.3A,3B, and3Care configured as liquid cryogen evaporators, where the outer surface of each spring-like structure may achieve a temperature between, approximately −20 Deg. C to −90 Deg. C., in response to liquid cryogen evaporation within. As previously described, the end effector described here may be optionally replaced by any of the other end effector embodiments described herein.

Spring-like structures39,44, and49are substantially flexible and are configured to conform to the morphology of a lateral nasal wall proximate to a target posterior nasal nerve with a substantially uniform contact pressure. Spring-like structures39,44, and49may be configured to be partially malleable and form shapeable by the user, while retaining a spring-like resilience during use. Spring-like structures39and44comprise distal end40and45respectively, and proximal end41and46respectively. Spring-like structures39and44comprise end cap38, which functions as a pressure bulkhead defining the distal end of the liquid cryogen evaporator that resides within, which is described in detail below. Spring-like structures39,44, and49comprise a tightly coiled wire that forms a central chamber, and an outer surface. A thin polymeric liner is disposed on the inner surface of the central chamber and functions to contain the evaporating cryogen within the central chamber. Cryogen is introduced into the central chamber through a liquid cryogen supply line, which runs through probe shaft20, and is in fluidic communication with the liquid cryogen flow control valve and the liquid cryogen reservoir previously described. Evaporated cryogen gas may be vented into the room out of the central chamber, through probe shaft20, then out of a vent port disposed in the vicinity of proximal end22of probe shaft20, not shown, or disposed in the surgical hand piece, also not shown. The construction and function of the disclosed embodiments of the spring-like structures is described in detail below.

FIG.4Ais a schematic illustration of a side view of the distal end of alternative embodiment surgical probe55comprising expandable membranous structure58encompassing, spring-like structure57in an un-expanded state.FIG.4Bis a schematic illustration of a side view of the distal end of surgical probe55with expandable structure or expandable membranous structure in an expanded state. In the depicted embodiment, expandable membranous structure58is configured as a liquid cryogen evaporation chamber. Liquid cryogen is introduced into the interior of expandable membranous structure58from spring-like structure57. Surgical probe55is configured so expandable membranous structure58expands to a predetermined size and shape in response to liquid cryogen evaporation within. While structure58may be expandable to a predetermined size and shape, the structure58may be comprised of a non-distensible material while in other variations, structure58may alternatively be comprised of a distensible material which allows for the expanded size and shape to vary depending upon the volume of cryogen introduced. Surgical probe55is configured such that the outer surface of expandable membranous structure58will be between approximately −20 Deg. C to −90 Deg. C. during cryogen evaporation within. The expanded size or shape of expendable membranous structure58is configured to substantially contact the surface of the cul-de-sac (element13inFIG.1which indicates the region of tissue region defined and surrounded by the middle nasal turbinate, inferior nasal turbinate, and lateral wall) when pressed against the lateral nasal wall be the surgeon. Expandable membranous structure58may be configured to form a hollow bulbous structure in its expanded state, and comprises a single ostium59configured for adhesive bonding to distal end62of probe shaft56using adhesive bond60. Cryogen exhaust vent61comprises at least one fenestration in distal end62of probe shaft40, which is in fluidic communication with a proximal vent port, not shown, and the room. A pressure relief valve, not shown, may be disposed in the fluid path between the interior of expandable membranous structure58and the room to control the pressure within expandable membranous structure58, and the degree of expansion during liquid cryogen evaporation. The construction and functionality of surgical probe embodiments comprising an expandable membranous structure are described in detail below.

FIG.5Ais a schematic illustration of a side view of the distal end of alternate embodiment of surgical probe68comprising expandable membranous structure69encompassing spring-like structure70. Spring-like structure70is configured with a lateral bend as depicted. Expandable membranous structure69is depicted in its un-expanded state.FIG.5Bis a schematic illustration of the same side view inFIG.5Aof alternate embodiment surgical probe68with expandable membranous structure69in its expandable state.FIG.5Cis a schematic side view illustration taken at view A-A fromFIG.5A.FIG.5Dis a schematic side view illustration taken at view B-B fromFIG.5B. Surgical probe68is configured with expandable membranous structure69functioning as a liquid cryogen evaporation chamber as depicted inFIGS.4A and4B. Liquid cryogen enters the interior of expandable membranous structure69from encompassed spring-like structure70. Evaporated cryogen gas exits the interior of expandable membranous structure69through fenestration(s)144in distal end143of probe shaft141and exits surgical probe68proximally into the room. Spring-like structure70is configured to pre-tension membranous structure69in one radial axis to a greater extent than a second radial axis in a manner that causes expansion to be constrained in the radial axis with greatest pre-tensioning. InFIGS.5A and5B, spring-like structure70is configured to pre-tension expandable membranous structure69to a greater extent in the radial axis that is normal to the view axis. InFIGS.5C and5D, spring-like structure70is configured to pre-tension expandable membranous structure69to a greater extent in the radial axis that is parallel to the view axis.FIG.5AandFIG.5Cdepict surgical probe68with expandable membranous structure69in its un-expanded state.FIGS.5B and5Ddepict surgical probe68with expandable membranous structure69in its expanded state. Pre-tensioning of expandable membranous structure69provides a means for achieving a predetermined expanded shape for optimal matching of the morphology of the target area of the lateral nasal wall.

FIG.6Ais a schematic illustration of a side view of the distal end of alternate embodiment of surgical probe79comprising expandable membranous structure80encompassing spring-like structure82. Spring-like structure82is configured as a loop structure as depicted. Expandable membranous structure80is depicted in its un-expanded state.FIG.68is a schematic illustration of the same side view inFIG.6Aof alternate embodiment surgical probe79with its expandable membranous structure80in its expandable state.FIG.6Cis a schematic side view illustration taken at view C-C fromFIG.6A.FIG.6Dis a schematic side view illustration taken at view D-D fromFIG.6B. Surgical probe79is configured with expandable membranous structure80functioning as a liquid cryogen evaporation chamber as depicted inFIGS.4A and4B. Liquid cryogen enters the interior of expandable membranous structure80from encompassed spring-like structure82. Evaporated cryogen gas exits the interior of expandable membranous structure69through fenestration(s)147in distal end146of probe shaft145and exits surgical probe79proximally into the room. Spring-like structure82is configured to pre-tension expandable membranous structure80in one radial axis to a greater extent than a second radial axis in a manner that causes expansion to be constrained in the radial axis with greatest pre-tensioning. InFIGS.6A and6B, spring-like structure82is configured to pre-tension membranous structure80to a greater extent in the radial axis that is normal to the view axis. InFIGS.6C and6D, spring-like structure82is configured to pre-tension expandable membranous structure80to a greater extent in the radial axis that is parallel to the view axis.FIG.6AandFIG.6Cdepict surgical probe79with expandable membranous structure80in its un-expanded state.FIGS.6B and6Ddepict surgical probe79with expandable membranous structure80in its expanded state. Pre-tensioning of expandable membranous structure80provides a means for achieving a predetermined expanded shape for optimal matching of the morphology of the target area of the lateral nasal wall.

Another alternative embodiment is illustrated in the side view ofFIG.6Ewhich shows a structure or member83which is formed into a looped and elongated structure having arcuate edges for presenting, an atraumatic surface. Rather than being formed as a spring like structure, the structure83may be formed of a relatively rigid wire or member instead which maintains its configuration when pressed against a tissue surface. Structure83may form a continuous structure which defines an opening there through such as a looped or elongated and looped member which is open through the loop. The structure83may be contained entirely within the expandable structure81which may be formed to have a predefined shape which is distensible or non-distensible when inflated by the cryogen. Moreover, the expandable structure81may be formed to surround the structure83entirely without being supported by or attached to the structure83itself. Such a structure83may provide a configuration which presents a low-profile as the device is advanced into and through the nasal cavity and between the nasal turbinate tissues. Yet because of the relatively flattened shape and rigidity and integrity of the structure83, the structure83may be used to manipulate, move, or otherwise part the tissues of the nasal cavity without having to rely upon the expandable structure81. Additionally, the low-profile enables the structure83to be positioned desirably within the narrowed confines of e.g., the cul-de-sac in proximity to the posterior nasal nerves (as shown by cul-de-sac13shown inFIG.1). When the expandable structure81is in its deflated state, it may form a flattened shape and when inflated, the expandable structure81may inflate into a configuration which remains unsupported by or attached to the structure83. Because the structure83may be formed of a member which solid along its length, the cryogen may be introduced directly into the expandable structure81through a distal opening defined in the probe shaft145.

Alternatively, structure83may be formed of a hollow tubular member which itself is formed into the continuous or looped shape. In such an embodiment, the cryogen may be optionally introduced through the hollow tubular member and dispersed within the interior of the expandable structure81through one or more openings which may be defined along the tubular member. In yet another alternative, the structure83may be formed into a flattened shape rather than a looped shape. In this configuration, the structure may be either solid or hollow such that that cryogen may be introduced through the structure and into the interior of the expandable structure81via one or more openings defined along the structure.

The structure83may extend and remain attached to the probe shaft145, but the remainder of the structure83which extends within the expandable structure81may remain unattached or unconnected to any portion of the expandable structure81. Hence, once the expandable structure81is inflated by the cryogen, the structure83may be adjusted in position or moved via manipulating the probe shaft145relative to the interior of the expandable structure81to enable the targeted positioning and cooling of the tissue region when in contact against the outer surface of the expandable structure81. For instance, the structure83may press laterally upon a particular region of the underlying tissue to stretch or thin out the contacted tissue region to facilitate the cryogenic treatment. When the structure83is adjusted in position relative to the expandable structure81, the expandable structure81may remain in a static position against a contacted tissue region allowing for limited repositioning of the structure83within.

Alternatively in other variations, the structure83may be attached along the interior of the expandable structure81partially at particular portions of the structure83or along the entirety of the structure83. For instance, structure83may be attached, adhered, or otherwise coupled over its entirety to expandable structure81while in other variations, a distal portion of structure83may be attached, adhered, or otherwise coupled to a distal portion of the expandable structure81while in yet other variations, portions of the structure83may be attached, adhered, or otherwise coupled to the expandable structure81along its side portions. Any of these variations may be optionally utilized depending upon the desired interaction and treatment between the structure83, expandable structure81, and underlying tissue region to be treated.

In yet another alternative variation, the lumen84for introducing the cryogen into the interior of the expandable structure81may be extended past the distal end of the probe shaft such that the cryogen is released, within the interior at a more distal location. As shown, the cryogen lumen84may be supported along the structure83, e.g., via a bar or member85which extends across the structure83. This particular variation may allow for the cryogen to be introduced into the distal portion of the interior of the expandable member81. Either this variation or the variation where the cryogen is released from an opening of the probe shaft may be utilized as desired.

FIG.6Fshows a side view of the embodiment ofFIG.6Eillustrating how the structure83can be formed from a relatively flattened configuration relative to the inflated expandable structure81. Because of the structural integrity of structure83and its relatively flattened profile, the structure83may provide for targeted treatment of the tissue when contacted by the device.FIG.6Gshows the side view of the inflated expandable structure81when pressed in a longitudinal direction by its distal tip against the underlying tissue surface S. The relative strength of the structure83provides for the ability to press the device against the tissue surface such that the remainder of the expandable structure81may maintain its inflated configuration to potentially insulate the other surrounding tissue regions.FIG.6Hlikewise shows the device when the structure83is pressed laterally along its side against the tissue surface S such that the structure83lies flat. The contacted tissue region may be treated while the remainder of the surrounding tissue is potentially insulated by the expanded structure81.

While the treatment end effector is designed for application along the tissue region defined by the cul-de-sac, the same end effector may be used in other regions of the nasal cavity as well. For instance, once the ablation is performed along the cul-de-sac, the end effector may then be moved to an adjacent tissue region, e.g., region immediately inferior to the cul-de-sac, and ablation treatment may be effected again. Additionally and/or alternatively, the end effector may also be used to further treat additional tissue regions, e.g., posterior aspect of the superior, middle, and/or inferior turbinates (any one, two, or all three regions). In either case, once the cul-de-sac has been ablated, the end effector may remain in place until the tissue region has thawed partially or completely before the end effector is moved to the adjacent tissue region for further treatment.

Once the treatment is completed, or during treatment itself, the tissue region may be assessed utilizing any number of mechanisms. For instance, the tissue region may be visually assessed utilizing an imager during and/or after ablation.

As described herein: the device may be utilized with a temperature sensor, e.g., thermistor, thermocouple, etc., which may be mounted along the shaft, within or along the expandable structure81, along the structure83, etc., to monitor the temperature not only of the cryogen but also a temperature of the tissue region as well under treatment.

Additionally and/or alternatively, the expandable structure81may also be vibrated while maintaining the structure83against the interior of the expandable structure81and the tissue region utilizing any number of vibrational actuators which may be mounted anywhere along the device as appropriate. The vibrations may be applied directly against the tissue region or, e.g., through a layer of gel to facilitate the vibrational contact with the tissue.

Additionally and/or alternatively, other biocompatible agents may be used in combination with the cryogenic treatment. For instance, in one variation, an anesthetic may be applied to the tissue region to be treated prior to or during the cryogenic treatment. This and other alternative features described may be utilized, not only with the variation shown and described inFIGS.6E and6Fbut with any other embodiments described herein.

FIG.7is a cross sectional schematic illustration of the distal end of a generic surgical probe89, which represents the construction and functionality of previously described surgical probe end effectors described above. Depicted is the distal end of probe shaft90, liquid cryogen supply line91, wire coil92, inner liner93, end cap94, metering orifices95, liquid cryogen96, liquid cryogen evaporation chamber97, and cryogen exhaust path98. Liquid cryogen evaporation chamber is defined by central channel134and inner liner93of wire coil92, end cap94at its distal end, probe shaft90at its proximal end. Wire coil92may be welded to end cap94and probe shaft90as shown. Alternatively, adhesive may be used for assembly. Probe shaft90may be formed from a surgical grade stainless steel hypodermic tube with an outside diameter between: e.g. approximately 1 mm and 4 mm. Wire coil92comprises a tightly coiled flat wire with a coil pitch that approximates the axial thickness136of wire135as shown. Wire135may be a stainless steel wire, or may alternatively be a nickel titanium super elastic alloy wire. Wire135has an axial thickness136between, e.g., approximately 0.5 mm and 1.5 mm; and a radial thickness137between, e.g., approximately 0.1 mm and 0.5 mm. Wire135may alternatively be a round wire with a diameter between, e.g., approximately 0.25 mm and 1.0 mm.

Inner liner93is depicted being disposed on the inner wall of wire coil92. Inner liner93is configured to provide a fluid tight seal of wire coil92. Inner liner93may be a polymeric material such as polyethylene, or PTFE. Alternatively a polymeric line may be disposed on the outer surface133to provide a fluid tight seal of wire coil92. Cryogen supply line91in fluidic communication with the supply of liquid cryogen in the liquid cryogen reservoir and liquid cryogen flow control valve in the surgical hand piece, not shown. Cryogen supply line91may be made from a thin walled tube with a high pressure rating, such as a polyimide tube. Cryogen supply line91delivers liquid cryogen96into liquid cryogen evaporation chamber97through metering orifice(s)95. Liquid cryogen supply line91has an inner diameter between, e.g., approximately 0.2 mm and 0.8 mm, and a wall thickness between, e.g.: approximately 0.05 mm and 0.5 mm.

Metering orifices95are configured to comprise a distribution of fenestrations in the distal end of liquid cryogen supply line91as shown, and are configured to distribute liquid cryogen96into liquid cryogen evaporation chamber97in a substantially uniform manner. The diameter and number of metering orifices95are configured such that the flow of liquid cryogen96into liquid cryogen evaporation chamber97is sufficient to lower the temperature of outer surface133to between, e.g., approximately −20 Deg. C., and −50 Deg. C. during liquid cryogen evaporation in order to effect a cryo-ablation, while limiting the flow of liquid cryogen96into liquid cryogen evaporation chamber97so that substantially all liquid cryogen evaporates within liquid cryogen evaporation chamber97. As depicted, liquid cryogen evaporation chamber97is an empty space. Alternatively, liquid cryogen evaporation chamber97may comprise a porous material configured to absorb the liquid cryogen96and prevent the liquid cryogen from leaving liquid cryogen evaporation chamber97while in a liquid state. Cryogenic gas leaves liquid cryogen evaporation chamber97through central channel139, and is vented into the room.

FIG.8is a cross sectional schematic illustration of the distal end of generic surgical probe104representing the construction and functionality of surgical probe embodiments55,68, and79previously described and depicted inFIGS.4A and48,FIGS.5A through5D, andFIGS.6A through6D, respectively. Depicted is the distal end of probe shaft105, wire coil structure106, end cap107, liquid cryogen supply line108, expandable membranous structure109, in its expanded state, ostium110, adhesive bond111between ostium110and probe shaft105, cryogen gas exhaust vent112, exhaust was flow path113, pressure bulkhead114, liquid cryogen evaporation chamber115, and liquid cryogen116. Wire coil106, probe shaft105, end cap107, and cryogen supply line108are substantially similar to corresponding elements described in detail and depicted inFIG.7, therefore, no further description is warranted. Expandable membranous structure109, ostium110, adhesive bond111, cryogen gas exhaust vent112, and exhaust gas flow path113are substantially similar to corresponding elements described in detail and depicted inFIGS.4A,4B,5A through5D, and6A through6D, therefore no further description is warranted. Liquid cryogen chamber139is defined by spring coil106, end cap107, and pressure bulkhead114. Liquid cryogen116enters liquid, cryogen chamber139through liquid cryogen supply line108, and through liquid cryogen ports137. Wire coil106is configured to meter liquid cryogen116from liquid cryogen chamber139into liquid cryogen evaporation chamber115in a manner that sprays liquid cryogen116in the direction of interior surface141of expandable membranous structure109so that the liquid cryogen rapidly evaporates upon contact with inner surface141. A perforated polymeric liner, not shown, disposed upon wire coil106may be used to provide proper metering and spatial distribution of liquid cryogen116.

FIG.9is an internal view of the nasal cavity showing surgical probe148comprising an expandable membranous structure123, configured as a liquid cryogen evaporator in position for a cryo-ablation of at least one posterior nasal nerve associated with middle nasal turbinate129, or inferior nasal turbinate128. Probe shaft122is associated with a surgical hand piece, not shown. Endoscope126, proximal end not shown, with field of view127is positioned to guide the correct surgical placement of spring-like structure125, and expandable membranous structure123against lateral nasal wall130at region124posterior to the middle turbinate as shown. Expandable membranous structure123is depicted in an expanded state. Alternatively, an endoscopic imaging means may be incorporated into the surgical probe148, along its shaft, which may comprise a CCD or CMOS imager

FIGS.10Athru10D are schematic illustrations of the distal end151of alternative embodiment paddle balloon probe150. Depicted is probe shaft154, expandable structure153, and paddle structure152.FIG.10Ais a front view illustration of distal end151with expandable structure153in an un-expanded state. Expandable structure153is maintained in its un-expanded state during introduction to, and removal from the target region of the nasal anatomy. Suction may be applied by a suction means to maintain expandable structure153in its un-expanded state.FIG.10Bis a side view illustration of the distal end151of paddle balloon probe150with expandable structure153in its un-expanded state.FIG.10Cis a front view illustration of the distal end151of paddle balloon probe150with expandable structure153in its expanded or inflated state.FIG.10Dis a side view illustration of the distal end of paddle balloon probe150with expandable structure153in its expanded or inflated state. Paddle152is configured for access to middle meatus of the lateral nasal wall by means of insertion between the middle nasal turbinate and the inferior nasal turbinate, as illustrated inFIGS.13Athru13D below. Paddle structure152is a rounded rectangular shape as shown with a major dimension between approximately, e.g., 8 mm and 16 mm, and a minor dimension between approximately, e.g. 4 mm and 10 mm. The thickness of paddle structure152is between approximately, e.g. 1 mm and 3 mm. Paddle structure152is sufficiently rigid to access the middle meatus between the middle nasal turbinate and the inferior nasal turbinate, and is sufficiently flexible to avoid trauma to the nasal anatomy during use. Expandable structure153comprises a membrane that is bonded to paddle structure152in a manner that forms a air tight bladder as shown. Paddle balloon probe150is configured for introduction of a liquid cryogen into the bladder formed by paddle structure152and expandable structure153, as well as to removed evaporated cryogen from the bladder with an exit to the room. The bladder formed by paddle structure152and expandable structure153is configured as cryogenic evaporation chamber, and the outer surface of expandable structure153is configured as a cryo-ablation surface. Expandable structure153is configured apply a force against the middle meatus of the lateral nasal wall between approximately, e.g. 20 grams and 200 grams. Expandable structure153is configured for expansion in reaction cryogen evaporation within. Liquid cryogen is introduced into the bladder through probe shaft154, and evaporated cryogen gas is removed from the bladder and vented to the room trough probe shaft154. The cryogenic ablation mechanisms and other features are similar to cryo-ablation probe embodiments described above and below.

FIGS.11A and11B are schematic illustrations of the distal end166of paddle porous balloon probe163, which is an alternative embodiment of paddle balloon probe150.FIG.11A is front view illustration, andFIG.11Bis a side view illustration. Paddle porous balloon probe163comprises probe shaft167, porous expandable structure165, and paddle structure164. Porous expandable structure165is similar to expandable structure153, described above, comprising a porous membrane versus an air tight membrane. Porous expandable structure165is configured for the venting of evaporated cryogen gas through the pores168from within the bladder formed by porous expandable structure165and paddle structure164into the patient's nostril in the immediate vicinity of the surface of the lateral nasal wall that is targeted for cryo-ablation. Venting the cold gas in the vicinity of the targeted lateral nasal wall enhances cooling effectiveness, while precluding the need to vent the evaporated cryogen gas through probe shaft167, allowing the probe shaft to be smaller in caliber, and therefore less traumatic. The cryogenic ablation mechanisms and other features are similar to cryo-ablation probe embodiments described above and below.

FIGS.12Athru12D are schematic illustrations of the distal end179of double balloon paddle probe178.FIG.12Ais a front view illustration of double balloon paddle probe178with expandable structure181in its un-expanded state.FIG.12B is a side view illustration of double balloon paddle probe178with expandable structure in its un-expanded state.FIG.12Cis a front view illustration of double balloon paddle probe178with expandable structure181in its expanded state.FIG.12D is a side view illustration of double balloon paddle probe178with its expandable structure181in its expanded state. Double balloon paddle probe178comprises probe shaft180, expandable structure181, paddle structure182, liquid cryogen port183, and cryogen gas exhaust port184. In this embodiment, expandable structure181encompasses paddle structure182and comprises a single ostium185, and an adhesive bond186which forms an air tight seal of for expandable structure181. The configuration and function of this embodiment substantially similar to the embodiment depicted inFIGS.6A to6H, with the difference being in this embodiment a paddle structure182is encompassed by expandable structure181, versus a spring-like structure or a formed wire structure encompassed by an expandable structure as depicted inFIGS.6A to6H. Optionally, the distal inner edge of paddle structure182and be bonded to the interior of expandable structure181by adhesive bond187.

FIGS.13A through13Dare schematic sectional coronal illustrations of the nasal cavity depicting ablation probe201access to the middle meatus198between the middle nasal turbinate6and inferior nasal turbinate7. Ablation probe201is a generic representation any of the ablation probes disclosed here within that utilize and expandable structure.FIG.13Adepicts the thin edge of the distal end of ablation probe201being inserted into the thin gap between middle nasal turbinate6and inferior nasal turbinate7.FIG.13Bdepicts the distal structure of ablation probe201behind middle turbinate against the middle meatus198in position for an ablation.FIG.13Cdepicts the initiation of ablation by activation of the flow of cryogenic liquid into the expandable structure203resulting in the inflation of the expandable structure203as shown. Please note, as depicted, the expandable structure is most similar to that depicted inFIGS.10and11, but is not intended imply a preference for those embodiments over the other embodiments disclosed here within.FIG.13Ddepicts the ablation zone204resulting from the application of a cryo-ablation of between approximately, e.g. 20 to 300 seconds. Following ablation, the probe may be removed following a thawing period that may be between approximately, e.g. 20 to 30 seconds. As depicted the sphenopalatine branch, comprising the sphenopalatine artery, sphenopalatine vein, and sphenopalatine nerve, and the sphenopalatine foramen are substantially encompassed by the zone of ablation204. As previously described, and further described below, the targeted tissue may comprise other locations, including the proximity of accessory posterolateral nerves bounded by a sphenopalatine foramen superiorly, an inferior edge of an inferior turbinate inferiorly, a Eustachian tube posteriorly, or a posterior third of the middle and inferior turbinates anteriorly. Other anatomical targets may include the pterygomaxillary fossa, sphenopalatine ganglion, or vidian nerve.

FIG.14Ais an internal lateral view of the nasal cavity showing target228for ablation of the parasympathetic nervous function of middle turbinate6. Ablation target228is directly over the posterior superior lateral nasal branches11which innervate middle turbinate6. Ablation target228may be circular as shown or non-circular, with a zone of ablative effect between 1 mm and 4 mm deep.FIG.14Bis an internal lateral view of the nasal cavity showing target246for ablation of parasympathetic nervous function of superior turbinate5, middle turbinate6, and inferior turbinate7. Ablation target246is linier as shown and is directly over posterior inferior lateral nasal branch10, which innervates inferior turbinate7, posterior superior lateral nasal branch11which innervates middle turbinate6, and superior lateral nasal branch12which innervates superior turbinate5. The depth of ablative effect is ideally between 1 mm and 4 mm deep.FIG.14Cis an internal lateral view of the nasal cavity showing target247for ablation of parasympathetic nervous function of superior turbinate5, middle turbinate6, and inferior turbinate7. Ablation target246is linier and segmented as shown with ablation segments directly over posterior inferior lateral nasal branch10, which innervates inferior turbinate7, posterior superior lateral nasal branch11which innervates middle turbinate6, and superior lateral nasal branch12which innervates superior turbinate5. The depth of ablative effect is ideally between 1 mm and 4 mm deep.FIG.2Dis an internal lateral view of the nasal cavity showing target248for ablation of the parasympathetic nervous function of middle turbinate6. Ablation target228is directly over the posterior superior lateral nasal branches11which innervate middle turbinate6. Ablation target248is oblong as shown and positioned between middle turbinate6and inferior turbinate7as shown, with a zone of ablative effect between 1 mm and 4 mm deep.

FIG.15Ais a schematic illustration of cryosurgical probe234configured for cryo-ablation of parasympathetic nervous function of a nasal turbinate(s) comprising a spatula shaped cryosurgical tip236. Cryosurgical probe234comprises handle235, probe shaft237cryosurgical tip236refrigerant cartridge cover239, and refrigerant control push button238. Handle235may comprise a receptacle, not shown, for receiving a refrigerant filled cartridge, not shown, which may comprise liquid carbon dioxide, which is used for evaporative cryogenic cooling within cryosurgical probe tip236. Alternatively, the cartridge may comprise a compressed cryogenic gas which may comprise argon or nitrous oxide which is used for Joule-Thompson effect cryogenic cooling within cryosurgical probe tip236. Those skilled in the art cryosurgical instrumentation are familiar with means for configuring cryosurgical probe234for evaporative cryogenic cooling or Joule-Thompson effect cryogenic cooling according to this invention, therefore, further detailed description relating to cryosurgical techniques are not warranted. Refrigerant control push button238is in mechanical communication with a valve which is configured to open when push button238is depressed by the operator causing the cryogen within the cartridge to flow into cryosurgical probe tip236through a conduit within probe shaft237. Handle235further comprises a venting means, not shown for exhausting the expanded cryogen into the atmosphere. Probe shaft237is between approximately 2 mm and 6 mm in diameter, with a length between approximately 4 cm and 10 cm.FIG.15Bdefines a section view of the cryosurgical probe234cryosurgical tip236.FIG.15Cis a cross sectional view of the cryosurgical probe234distal end comprising probe shaft237, refrigerant delivery tube253, and probe tip236. Cryogen delivery tube253traverses the length of probe shaft237in a coaxial relationship and is in fluidic communication with the cryogen cartridge in handle235through the cryogen control valve previously described. At the distal end of cryogen delivery tube253there is at least one lateral fenestration configured to direct the release of the pressurized cryogen256from cryogen delivery tube253into expansion chamber251of cryosurgical tip236in the direction of cryo-ablation surface249of cryosurgical tip236. Cryo-ablation surface249is substantially flat. The opposing surface250to ablation surface249may be cylindrical as shown. By directing the release of cryogen towards ablation surface249, ablation surface249achieves cryo-ablation temperatures between approximately −20 to −200 degrees centigrade, and opposing surface250remains warmer. The expanded cryogen255exits expansion chamber251through probe shaft252and is vented to atmosphere through handle235as previously described. Probe shaft237, cryogen deliver tube253, and cryosurgical tip236may fabricated from a stainless steel as is typical with cryosurgical probes, or may be fabricated with alternative materials as is familiar to those skilled in the art of cryosurgical probes. Probe shaft237may configured as shown with curvatures configured for nasal anatomy, or alternatively may be configured as described below.

FIG.16Ais a schematic illustration of the distal end of an alternative embodiment262of the cryosurgical probe comprising a bullet shaped cryo-ablation element263at the distal end of angled probe shaft265. In this embodiment pressurized cryogen is released through an orifice in an axial direction into the expansion chamber in the direction cryo-ablation surface264. The diameter of shaft265is between approximately 2 mm and 6 mm, and the angle of shaft265is between approximately 30 and 60 degrees, and the point of bend is between 1 cm and 3 cm from the distal end of ablation element263.FIG.16Bis a schematic illustration of the distal end of an alternative embodiment266of the cryosurgical probe comprising a bullet shaped cryo-ablation element263at the distal end of a user deflectable probe shaft267. Deflectable probe shaft267comprises distal deflectable segment268and a substantially rigid non-deflectable proximal segment269. Probe shaft267diameter is between approximately 2 mm and 6 mm. The border between deflectable distal segment268and proximal non-deflectable segment is between approximately 1 cm and 3 cm from the distal end of ablation element263. The angle of deflection may be between approximately 60 to 120 degrees and may be configured for deflection in one direction, or in two directions as shown. The deflection means comprises at least one pull wire housed within probe shaft267and a deflection actuator disposed in the vicinity of the proximal end of probe266. Those skilled in the art deflectable tipped surgical probes are familiar means for creating a deflectable tipped cryosurgical probe according to this invention.FIGS.16C and16Dare schematic illustrations of the distal end of an alternative embodiment270of the cryosurgical probe where the cryo-ablation element274is configured for producing multiple discrete cryo-ablations simultaneously. Cryo ablation element274comprises an expansion chamber, not shown, discrete lateral cryo-ablation surfaces272, surrounded by thermal insulation273. Ablation element274comprises a hollow bullet shaped metallic structure with lateral protrusions in the surface forming cryo-ablation surfaces272, with a thermal insulating material covering all remaining external surfaces of ablation element274as shown. As with cryo-surgical probe234, cryogen is released from cryogen delivery tube in a lateral direction towards cryo-ablation surfaces272.

FIG.17Ais a schematic illustration of the distal end of an alternative embodiment280of the cryosurgical probe comprising a semi-circular cryo-ablation element282. Cryo-ablation element282comprises a continuation of probe shaft281formed in a semi-circle as shown. Within the semi-circular section cryogen delivery tube283comprises an array of lateral fenestration in the one axial direction relative to semi-circular form, making the corresponding surface of the ablation element282the cryo-ablation surface.FIG.17Bis a schematic illustration of the ablation284morphology in the nasal mucosa288resulting from use of the semi-circular ablation element282. The gap286in the ablation provides blood perfusion to the mucosa encompassed by the ablation providing a reduction in tissue sloughing as the result of the ablation, as well as a reduction in the chance of infection, and a reduction of patient discomfort.FIG.17Cis a schematic illustration of the distal end of an alternative embodiment287of the cryosurgical probe comprising a spiraled cryo-ablation element.

FIG.18Ais a schematic illustration of cryo-ablation balloon probe294configured for cryo-ablation of parasympathetic nervous function of a nasal turbinate(s). Cryo-ablation balloon probe294comprises balloon295, probe shaft296, cryogen delivery tube297, with lateral fenestrations298disposed on the distal end of cryogen delivery tube297within balloon295as shown. Cryo-ablation balloon probe294further comprises proximal hub299with cryogen exhaust port299, cryogen supply port301. Probe shaft296may be rigid or flexible. Balloon295functions as a cryogen expansion chamber for either a cryogenic evaporation cooling process or a Joules-Thompson effect cooling process. Pressurized cryogen256is delivered to the interior of balloon295through cryogen delivery tube297wider pressure. Cryogen256exits cryogen delivery tube297through lateral fenestrations298as shown, in the radial direction towards the wall of balloon295. The radial wall of balloon295is the cryo-ablation surface. Expanded cryogen255exits balloon295through probe shaft296, and is vented to atmosphere through exhaust port300. Exhaust port300may comprise a pressure relief valve, which creates a back pressure to inflate balloon295at a predetermined pressure. Cryogen supply port301is configured to connect cryogen supply tube297to a source of cryogen. Proximal hub299may be configured as a handle, and comprise a cryogen control valve.FIG.18Bis a schematic illustration of the distal end of the cryo-ablation balloon probe detailing the geometry of the cryo-ablation balloon. The length302of balloon295is between approximately 3 mm and 20 mm, and the diameter303of balloon295is between 1 mm and 5 mm.FIG.18Cis a schematic illustration of an alternate embodiment304of the cryo-ablation balloon probe294comprising an insulating chamber307within the cryo balloon305structure. Insulating chamber307is formed by membrane306as shown. Fenestration308is a small opening in communication between expansion chamber311and insulating chamber307, which allows insulation chamber to inflate with expanded cryogen gas255in a substantially static manner providing thermal insulation to the surface of balloon305adjacent to insulation chamber307. Lateral fenestrations310direct pressurized cryogen301towards the wall of balloon305opposite of insulation chamber307forming cryo-ablation surface312. The length302of balloon305is between approximately 3 mm and 20 mm, and the diameter of balloon305is between approximately 1 mm and 6 mm.FIG.18Dis a schematic illustration of the distal end of an alternative embodiment313of the cryo-ablation balloon probe294comprising a tee shaped cryo-ablation balloon314. The length302of balloon314is between approximately 3 mm to 20 mm, and the diameter of balloon303is between approximately 1 mm and 6 mm. Cryogen delivery tube315is configured to direct pressurized cryogen down the horns316of balloon314as shown.FIG.18Eis a schematic illustration of the distal end of an alternative embodiment317of the cryo-ablation balloon probe294comprising a “J” shaped cryo-ablation balloon318. The length302of balloon318is between approximately 3 mm and 20 mm, and the diameter303of balloon318is between approximately 1 mm and 6 mm. Cryogen delivery tube319is configured to direct pressurized cryogen256laterally into the “J” as shown.

FIG.19Ais a schematic illustration of the distal end of an alternate embodiment325of cryo-ablation probe294comprising a cryo-ablation element326with suction stabilization.FIG.19Bis a cross sectional view of the distal end of the alternative embodiment325showing the configuration of the cryo-ablation element326and the suction stabilization means.

Ablation element326is surrounded by suction chamber329as shown. Suction chamber329is in fluidic communication with a suction source, not shown, by suction tube331. Suction ports330are oriented in the same direction as cryo-ablation surface332and are configured to provide suction attachment to the tissue when cryo-ablation surface332is placed into contact with the nasal mucosa in the ablation target zone. Probe shaft325, cryogen delivery tube327, and lateral fenestrations328have similar function those previously described.

FIG.20Ais a schematic illustration of radiofrequency (RF) ablation probe338configured for ablation of the parasympathetic nervous function of a nasal turbinate(s) with a bi-polar ring electrode ablation element342on an “J” shaped distal probe tip341. RF ablation probe338comprises handle339, probe shaft340, “J” shaped probe tip341, bipolar ring electrode pair342: RF activation switch345, electrical connector343, and fluid connector344. Those skilled in the art of RF ablation probes are familiar with the many possible configurations and construction techniques for RF electrodes and probes that are within the scope of this invention, therefore detailed description of the illustrated, electrode configurations described below, and their construction techniques is not warranted. Electrical connector343is configured for connection to a radiofrequency energy generator, for which there are many commercially available. Fluid connector344is configured for connection to source of liquid irrigant. Fluid connector344may be in fluidic communication with at least one fluid irrigation port located the vicinity of the RF ablation electrode, and is embodiment specific. RF activation switch345allows the user to activate the RF ablation and terminate the RF ablation. Probe shaft340is between approximately 2 mm to 6 mm in diameter, and between approximately 4 cm and 10 cm long, but could be longer. The length of “J” tip341is between approximately 0.5 cm and 1.5 cm. Ring the spacing between RF electrode pair342is between approximately 2 mm and 6 mm.FIG.20Bis a schematic illustration of the distal end of an alternative embodiment346of RF ablation probe338comprising a bi-polar segmented ring electrode ablation element on an “J” shaped distal probe shaft. The gap348shown in the ring electrode is on the side opposite of the side configured for RF ablation. The gap348in the ring electrodes protect the nasal septum during RF ensuring that RF energy is only applied to the lateral nasal wall at the ablation target.FIG.20Cis a schematic illustration of alternative embodiment349of the distal end of RF ablation probe338comprising a bi-polar electrode ablation element350on a “J” shaped distal probe shaft with the electrodes disposed in a lateral array.FIG.20Dis a schematic illustration of alternative embodiment351of the distal end of RF ablation probe338comprising a bi-polar electrode ablation element352on a “U” shaped distal probe shaft353with the electrodes disposed in a lateral array.FIG.20Eis a schematic illustration of the distal end of alternative embodiment354of RF ablation probe338comprising a bi-polar electrode ablation element355on a user deployable “T” shaped structure356. Element356is comprised of two halves which can alternately be collapsed and deployed as inFIG.20E. The two halves of the electrode structure356are pivoted to allow them to move laterally relative to the catheter shaft354. Electrodes355can operate in a mono polar, bipolar or multipolar fashion as known in the art.

FIG.21Ais a schematic illustration of alternative embodiment362to RF ablation probe338configured for ablation of the parasympathetic nervous function of a nasal turbinate(s) comprising an array of RF ablation electrodes363disposed on a planar surface with a fluid irrigation means associated with the electrodes.FIG.21Bis a schematic illustration of the distal end of the RF ablation probe362showing the arrangement of the ablation electrode array363and the associated fluid irrigation means. Alternative embodiment362comprises distal probe tip119, probe shaft369, handle339, fluid connector344, and electrical connector343. Electrode array363comprises two or more dome shaped electrodes365, that are electrically configured into a bipolar pair, meaning that if there are 4 electrodes365, then two of the electrodes are connectable to one pole of an RF generator, and the second two electrodes are connectable to the opposite pole of the RF generator, etc. Electrodes365are dome shaped and protrude from planar surface366. A fluid port364is associated with each electrode365. All fluid ports are in fluidic communication with fluid connector344. Fluid ports364are configured to irrigate the surface of the nasal mucosa that is contact with electrodes365to provide cooling of the mucosa and the electrodes365, to minimize thermal injury to the surface of the mucosa, and to prevent sticking of the electrodes to the surface of the mucosa. Probe tip371is between approximately 4 mm and 8 mm in diameter, and between approximately 3 mm to 8 mm thick. The number of electrodes365of electrode array363may be between 2 and approximately 10.

FIG.22Ais a schematic illustration of an alternative embodiment377of RF ablation probe362comprising a linear electrode array378disposed on a planar surface; a fluid irrigation ports387associated electrodes379, and a deployable needle380configured for injecting a liquid into a sub-mucosal space.FIG.22Bis a schematic illustration of the distal end of the alternative embodiment377RF ablation probe showing the arrangement of the ablation electrodes379and the associated fluid irrigation ports387.FIG.22Cis a schematic illustration of the distal end of the alternative embodiment377RF ablation probe showing the arrangement of the ablation electrodes379and the associated fluid irrigation ports387with the needle380deployed. The function, of domed electrodes379, fluid ports387, electrical connector343, fluid connector344, RF activation switch345, handle382, and shaft384all function in essentially the same manner as described for prior embodiment362. This embodiment has a linear electrode array378, and a deployable needle configured for injecting a liquid into the sub-mucosal space where the liquid may comprise an anesthetic. Needle actuator383provides the user a means actuating needle380. Fluid connector389is in fluidic communication with needle380, through needle shaft385, and is configured with a female luer connector for mating with a syringe, not shown. Shaft384contains needle shaft385, electrical cable386, and provides a conduit for irrigation fluid, not shown.

FIG.23Ais a schematic illustration of an RF interstitial needle ablation probe395configured for interstitial ablation of a posterior nasal nerve.FIG.23Bis a schematic illustration of the distal end396of the RF interstitial needle ablation probe395. RF interstitial needle probe395comprises distal tip396, probe shaft398, handle399, electrical connector400, fluid connector401, RF activation switch402. Distal tip396comprises interstitial needle electrode array397, which comprises more than one interstitial needle464Handle,399, RF activation switch402, electrical connector400, and probe shaft398function in a manner previously described. Fluid port401is in fluidic communication with at least one RF ablation needle464, with the at least one RF ablation needle464being hollow and configured for injecting a liquid into the nasal sub-mucosal space. Each RF ablation needle464has a proximal electrically insulating coating405, and a distal electrically insulating coating404, forming RF electrode surface403. Proximal insulator405, and distal insulator404are configured for limiting the ablation effects to the sub-mucosal space, which will be described in further detail below. Interstitial needle electrode array397may be configured as a mono-polar electrode array, or a bipolar electrode array. Interstitial needle electrode array397may be configured as a linear array, a circular array, a triangular array, or any other geometric form. Interstitial needle electrode array397may comprise two or more RF ablation needles464. RF ablation needles464are between approximately 18 and 28 gauge, and between approximately 3 mm and 10 mm long.

FIG.24Ais a cross sectional view of the distal end of an alternative embodiment411to RF interstitial needle ablation probe395comprising a deployable and retractable array of RF ablation needles412configured for lateral deployment showing the needle array retracted.FIG.24Bis a cross sectional view of the distal end of an alternative embodiment411of RF interstitial needle ablation probe395comprising a deployable and retractable array of RF ablation needles configured for lateral deployment, showing the needle array deployed interstitial needle array412is housed in a hollow sheath with a “J” tip413as shown. Linear actuator shaft414is in mechanical communication with a user actuator lever at the proximal end not shown. Linear actuator shaft414is moved in the distal direction to deploy needle array412, and moved in the proximal direction to retract needle array412as shown.FIG.24Cis a cross sectional view of the distal end of an alternative embodiment415of RF interstitial needle ablation probe395comprising a deployable and retractable array of RF ablation needles configured for axial deployment showing the needle array retracted.FIG.24Dis a cross sectional view of the distal end of an alternative embodiment415of RF interstitial needle ablation probe395comprising a deployable and retractable array of RF ablation needles configured for axial deployment showing the needle array deployed.

FIG.25Ais a schematic illustration of an integrated flexible circuit421configured for use with an RF ablation probe comprising an RF energy source and control circuits422at one end, and an RF ablation electrode array423at the opposite end, connected by electrical conduits426.FIG.25Bis a schematic illustration of the RF ablation electrode array423of the flexible circuit mounted on the distal shaft of an RF ablation probe that is configured for ablation of the parasympathetic nervous function of a nasal turbinate. Also shown are optional fluid ports associated with the RF ablation electrode array as shown, with irrigation fluid427supplied to irrigation ports425through distal shaft424.

FIG.26Ais an in situ schematic illustration of the RF ablation probe377depicted inFIGS.10through10Cshowing needle380injecting an anesthetic into the sub-mucosal space433prior to an RF ablation of the posterior nasal nerve434.FIG.26Bis an in situ schematic illustration of the resulting RF ablation436showing the ablation zone436encompassing posterior nasal nerve434, and residing below the mucosal surface437due to the cooling effect of liquid irrigant435.

FIG.27is an in situ schematic illustration of an RF ablation of the parasympathetic nerve of a posterior nasal nerve434using the RF interstitial needle ablation probe395depicted inFIGS.11A and11Bshowing ablation zone436encompassing posterior nasal nerve434and residing below the mucosa surface437due to the arrangement of needle electrode surface(s)403and needle insulation zones404&405.

FIG.28is an in situ illustration of the ablation of the posterior nasal nerve depicted inFIG.14D. Generic ablation device441is shown with cylindrical ablation element442, which could be a cryo ablation element, an RF ablation element, or some other type of thermal ablation element. Also shown is endoscope443, which provides the surgeon an image for positioning ablation element442at the target location, and a means for monitoring the ablation.

FIG.29is an in situ illustration of the ablation of the posterior nasal nerve of a nasal turbinate at the ablation target depicted inFIG.14B. Generic ablation device441is shown with cylindrical ablation element442, which could be a cryo ablation element, an RF ablation element, or some other type of thermal ablation element. Also shown is endoscope443, which provides the surgeon an image for positioning ablation element442at the target location, and a means for monitoring the ablation.

FIG.30is an in situ illustration of the ablation of the posterior nasal nerve using a generic “T” tipped ablation device448. Generic “T” tipped ablation device448is shown with ablation elements449, which could be cryo ablation elements, RF ablation elements, or some other type of thermal ablation elements. Also shown is endoscope443, which provides the surgeon an image for positioning ablation element442at the target location, and a means for monitoring the ablation.

FIG.31Ais a schematic illustration of generic ablation probe455and an insulated probe guide457configured to protect the nasal septum from thermal injury during an ablation of the parasympathetic nervous function of a nasal turbinate(s). Probe guide457is configured to press ablation element456of probe455against the lateral all of a nasal cavity458and create a thermally insulative space between the lateral wall of the nasal cavity458and the nasal septum459as shown inFIGS.31B and31C. Probe guide457may be fabricated from foam material, or any other suitable thermally insulative material.FIG.31Bis an in situ illustration of generic ablation probe437configured for ablation of the posterior nasal nerve which comprises an insulating structure460configured to protect the nasal septum459from thermal injury. Structure460may comprise an inflatable balloon.FIG.31Cis an in situ illustration of generic ablation probe455configured for ablation of the parasympathetic nervous function of a nasal turbinate(s) which comprises a space creating structure461configured to protect the nasal septum459from thermal injury. Structure461may comprise a deployable wire structure or surgical basket structure.