US2087108A - Tonsillotome - Google Patents

Description

W. H. IRVINE TONS ILLOTOME July 13, 193 7.

Filed Oct. 50, 1954 dlw .N

wm m V I Wham WHHA Patented .Fully 13, 1937 5:11, TPS

'EUNSELLOTMIE Application October 3l), i934, Serial No. 750,619

'i' Claims.

This invention relates to tonsillotomes and while the instrument is primarily adapted for the removal of tonsils it is also adapted for use in other surgical operations.

It is an object of the invention to provide an improved tonsillotome embodying an craseur with means to position the same relative to the tonsilar space in the passage from the mouth tol the pharynx with means to actuate the craseur to effect enucleation or extirpation oi the tonsil by compressing the tonsil at the base or neck to prevent hemorrhage and the abscission of the tonsil pedicle.

ln instruments of this character heretofore l5 there has been provided a carrier bar arranged as a handgrip at one end and the opposite eX- tremity arranged with a member o distal fenestra form as a means to approach the tonsilar space, the craseur comprising a strand o' suitable material, preferably wire, attached at the opposite ends to a slide mount-ed upon the carrier bar intermediate the handgrip and distal member, the wire being arranged intermediate the ends to loop form and the loop expanded and 25 positioned relative to a recess interior of the fenestra wall of the distal member and positioned about the tonsil by the distal member and said loop in the removal of the tonsil being gradually diminished or contracted to compress the tonsil by moving the slide upon the carrier bar. In such instruments the distal member is of flat form with the result that when it is positioned relative to the tonsilar space only an intermediate portion of the tonsil will be embraced by the craseur loop and it is impossible to extirpate the tonsil and only a part of the tonsil may be removed, as by cutting. It is a further object oi the invention to overcome this disadvantage by arranging the distal member of ovate or spoon shape, that is, ci convex form in longitudinal and transverse section, and offset the distal member relative to its carrier at the juncture o the distal member with the carrier, whereby the tonsilar space may be more closely approached by the distal member and position the loop of the craseur to engage and compress the tonsil at the base or neck and assure the enucleation or extirpation of the tonsil, and the provision of means to guide the craseur during the actuation thereof.

A further object of the invention is to provide in tonsillotomes means to co-operate with the craseur to effect an abscission of the pedicle of the tonsil enucleated or extirpated by the ecra- Seur.

(Cl. 12S-309) 1t is another object of the invention to provide the tonsillotcmes with a fenestra distal member and arrange a portion of the enestra wall with a cutting edge disposed in opposed relation to the outermost curved portion of the enestra Wall and the craseur loop when positioned in the recess in the outer portion oi the fenestra Wall of the distal member tol co-operate with they craseur loop during the diminishing of said loop to cleave the pedicle of the enucleated tonsil thereby and eiiect abscission of the tonsil.

Other objects and advantages will hereinafter appear.

In the drawing accompanying and forming a part of this application, Figure 1 is a plan View of my improved tonsillotome showing the craseur wire in partially diminished or contracted position.

Figure 2 is a side elevation, partly in section, to show the connection. of a thumb or nger engaging member with a carrier bar for the operative parts of the tonsillotome, and showing means to releasably lock the craseur actuating slide in adjusted position on the carrier bar and showing the same in slid-e releasing position.

Figure 3 is a longitudinal sectional view of the distal member to` show the connection thereof with the carrier member, the arrangement of the craseur wire relative thereto, and the cutting means to e'i'ect abscission of the pedicle of an enucleated tonsil, the section being taken substantially on the line 3 3 of Figure 1 looking in the direction of the arrows.

Figure 4 is a sectional view, on an enlarged scale, taken on the line l-l of Figure 1 looking in the direction of the arrows to show the arrangement of the craseur actuating slide and the means to releasably lock said slide to the carrier bar.

Figure 5 is a cross sectional View taken on the line 2i- 5 of Figure l looking in the direction of the arrows to show the mounting of the means to releasably lock the craseur actuating slide on the carrier bar.

Figure 6 is a cross sectional View taken on the line (-t of Figure 1 looking in the direction of the arrows to show the arrangement of the connection of the distal and bar members and the arrangement oi the cutting means to cooperate with the craseur wire to effect abscission of the pedicle of the tonsil; and

Figure 7 is a View taken substantially on the line l-l of Figure 1 looking in the direction of the arrows to show the arrangement of guides at opposite sides of the carrier bar for the engagement and guiding of the craseur wire.

In carrying out the embodiment of the invention illustrated in the drawing there is provided a carrier for the operative parts of the device in the form of a bar 8 arranged at one end portion as a handle, the bar preferably being of rectangular shape in cross section having a reduced screw threaded shank 9 extended from one end for the threaded connection of an annular thumb or nger engaging member Ill. The opposite end portion is arranged of increased width, as at II, and the extremity arranged as a member of distal fenestra form in that the end wall is of arcuate form and has a circular therethrough with the outer end wall opening of annular form and extending through an arc slightly greater than 180 degrees, as shown at I2 in Figure l, and provided in the interior surface thereof with a groove or recess I3, as shown in Figure 3. 'I'he distal member is of ovate or spoon shape in that it is of convex form in longitudinal and transverse section and is 01T- set laterally of the carrier bar 8 substantially midway the ends of the portion of increased width II, as at M. The wall of the opening in the distal member opposite the annular wall portion I2 is arranged as a cutter I5, the cutting edge I 5 of which extends substantially in an arc of 180 degrees and merging at the opposite ends with the annular wall portion I2. This cutter is formed by undercutting or recessing the upper surface of the handle at the juncture of the distal member rearwardly from the cutting edge I5 to a point substantially at the oiset of the distal member, as at I6, thereby arranging the cutter of a thickness substantially the same as the outer convex wall of the recess I3 and said cutting edge merging in said recess wall. The opposite side wall of the recess I3 is'of the same width for an arc of substantially 180 degrees when it is reduced in width to less than the width of the extremities of the arcuate cutting edge, as at I2', and then merges with portions of arcuate form, as at II, of the side wall of the undercut portion I6, the wall of said arcuate portions being recessed or undercut to constitute in effect continuations of the recess I3 and spaced apart a distance less than the diameter of the opening in the distal member to extend substantially in line with guideways in the form of bores I8 through the portions of increased width at opposite sides of the carrier bar 8, the end wall of said undercut portion I6 also being recessed and the end wall of the recess arranged of arcuate form, as shown at I9 in Figures 1 and 6. The cutter I5 is of concave form in cross section, as shown in Figures 3 and 6, and diminishes to flat form rearwardly from the cutting edge to where it merges with the carrier bar 8. It will be obvious that by this arrangement of the distal member that the tonsilar space in the passage of the mouth to the pharynx may be closely approached by the convex surface thereof with the wall of the opening in the distal member embracing the base or neck of the tonsil.

To enucleate or extirpate the tonsil and simultaneously therewith compress the tonsil at the base or neck to prevent hemorrhage an craseur of suitable material is provided, preferably consisting of a wire loop 20 formed by bending a strand of wire upon itself intermediate the ends with the opposite ends extended through the guide bores I8 whereby the loop may be positioned relative to the recess I3 in the wall I2 of the opening in the distal member and the recesses in the parts I'I, as shown in Figure 1. The craseur loop is normally positioned and concealed within the recess I3 of the distal member, as shown in Figure 3, and to effect a gradual diminishing or contraction and movement of the loop across the opening in the distal member, the opposite ends of the wire are releasably connected to an actuator mounted on the carrier bar 8. In the embodiment shown this actuator comprises a slide 2i of rectangular shape in cross section having an opening therethrough conforming to and for slidable engagement on the carrier bar 8, the slide being provided with oppositely extending annular finger grips 22. The actuator slide with the finger grips may be a casting, or the same may be formed of sheet metal and the nger grips secured thereto, as by welding. To releasably secure the ends of the wire to the actuator slide they are extended through openings in the juncture of the nger grips 22 with the'slide, as at 23, and releasably clamped to the ringer grips by coiling the extremities of the wire about and below the heads of screws threaded into the finger grips, as shown at 24 in Figures 1 and 2.

To releasably lock the slide against movement on the carrier bar with the craseur loop engaging the recess I3 in the distal member or in either of its diminished or actuated positions, the actuator slide for the craseur is provided with a loci:- ing detent to engage in either one of a series of transverse notches 25 spaced longitudinally of the carrier bar. This locking detent is shown in the form of a plate 26 of resilient material secured in juxtaposed relation to the slide 2I by lips 2? extended upward from the slide and engaging over the opposite marginal side portions of the plate adjacent one end, as shown in Figure 1. The one end of the plate extends beyond the end or the slide opposite the craseur wire and is provided with a laterally extending pawl 28 to engage a notch 25 under the inherent tension of the plate.

To release the detent from a notch 25 and retain it in released position to permit of free sliding movement of the craseur actuator slide on the carrier bar to adjust the craseur loop to position within the recess I3 of the distal member and to diminish or contract said loop, means are provided to move the pawl end of the detent plate against its inherent tension and thereby disengage the detent pawl from a notch 25 and hold said end of the detent in such position. For this purpose the opposite plate intermediate the attaching ears 21 and pawl end of the detent plate are arranged with eyes 29 to be disposed in parallel relation to the periorations in ears 3i] extended upward from the slide 2I for the pivotal engagement of the ends of a pintle SI arranged with cams 32 disposed within the eyes 29 of the plate, the pintle being provided with an operating lever or nger grip 33. position of the actuating lever to extend in contiguous relation to the detent plate 26 with the cams out of engagement with the eyes 29 of the detent, as shown in Figure 4, the parts being retained in said position by the inherent tension of the detent plate. To move the detent pawl 28 out of engagement with a bar notch the lever is actuated to the position shown in Figure 2, thereby rotating the pintle 3I and therewith the cams 32 which move the plate against its inherent tension to p0- sition the detent pawl out of engagement with a marginal portions of the bar notch, as shown in Figure 2, the plate co-operating with the cams toretain it in said position.

In operation the craseur actuating slide 2l is released from the carrier bar to permit movement of the actuator slide upon said bar. The craseur loop is then adjusted to position it within the recess l3 of the distal member, when the detent plate 26 is released to permit it under its inherent tension to engage the pawl 28 with a bar notch 25. With the parts in said positions the tonsilar space is approached by the convex surface of the distal member to engage the tonsil in the opening therein. With the instrument so positioned the craseur actuator slide is actuated to diminish or contract the craseur loo-p which may be effected by engaging the iingers within the ringer grips 22 of the actuator and support the instrument with the other hand grasping the nger grip Il), or the finger grip l may be engaged by the thumb of the hand the fingers of which engage the linger grips 22 of the actuator. The detent pawl 28 may be so arranged that b-y exerting a predetermined force on the actuator through the finger grips 22 to cause the pawl to yieldingly ride over the bar notches, or the detent may be released by the lever 33 before operating the craseur actuator, which may be readily effected by engaging the finger or thumb nail below the end of the lever 33 and exerting an outward force thereon.

By the arranging of the distal member of ovate or spoon form and offsetting the distal member relative to its carrier bar, the craseur loop may be positioned closely to the base or neck of the tonsil, and asthe loop is partly contracted and moved out of the -groove I3 it has a tendency to move laterally and downwardly from the distal member due to the inherent tension of the wire and be forced into the tonsilar space. This diminishing of the loop is gradual and effects a compressing of the tonsil and the simultaneous enucleation or extirpation of the tonsil. Simultaneously with the diminishing of the ecraseur loop, it is moved relative to the cutting edge i5 and effects an abscission of the tonsil pedicle. This is efficiently accomplished by the arrangement of guiding the ecraseur wire through the guideways I8 and causing a movement of the compressed tonsil relative to and in the direction of the cutting edge l5', and said cutting edge due to the concave form and the form of the cutting edge, which is in the nature of a shear edge beveled inward from the concave side to the convex side, and the guiding of the craseur wire relative to the walls Il, causes the craseur wire to be moved in contiguous relation to the convex face of the cutter and cutting edge and thus assuring a positive abscission of the tonsil and its pedicle by the cutter. The craseur actuator is operated until the craseur loop is moved relative to the cutter I5, which is in the nature of a shelf, and the loop is positioned relative to the arcuate wall of the recess i9, when there will be a complete abscission of the tonsil and the tonsil pedicle. Should the tonsil pedicle be tough with the result that there may not have been a complete abscission of the tonsil pedicle by the cutter I5 by adjustment of the craseur loop to position relative to the arcuate wall of the recess I9 will cause such portion of the enucleated tonsil pedicle to lie relative to the shelf or cutter and in which position it may be readily snipped ci by a pair of scissors.

It will be obvious that the parts may be readily disassembled for cleaning or substitution of parts and as readily reassembled by releasing the ends of the craseur wire 2B from the attaching screws 261 when the wire may be readily withdrawn from the guideway it, and by the unscrewing of the l'inger grip it from the carrier bar the craseur actuator slide 2l may be read- -ily removed from the carrier bar.

To effect a cauterizing of the tonsil pedicle the craseur wire may be connected in circuit with a source of electricity to effect a heating of the loop, in which case the carrier bar with the distal member, as well as the craseur actuator slide, will be made of an insulating material, such as bakelite.

While I have illustrated and described one embodiment of my invention, it will be obvious that modiications may be made in the construction and arrangement of parts Without departing from the scope of the invention, and that parts of the invention may be used without others and come within the scope of the invention.

Having thus described my invention, I claim:

l. In a tonsiliotorne, a handle having an end portion of increased width terminating at the end in a fenestra of ovate form having a circular opening therein and adapted to approach the tonsilar space with the fenestra wall embracing the tonsil, said fenestra opening having a recess in and extending about the outer portion of the wall of the opening and communicating at the juncture of the ovate fenestra portion with the handle with a guideway at each opposite side of and extending parallelly oi the handle, a wire looped upon itself and the opposite ends extended relative to said guideways in the handle and the looped portion adapted to be positioned in the recess in the wall of the enestra opening, and means to which the ends of the wire are attached slidably mounted on the handle and operative to move the loop relative to the fenestra opening.

2. In a tonsillotome, a wire looped upon itself intermediate its ends, a member including a handle having an end portion of increased width arranged at the end of ovate shape having a circular opening therein with a recess and guide in the outer portion of the wall of said opening for the engagement of the wire loop, a guideway at each side of the portion of increased width of the handle within the ovate shaped end and at each side of the handle merging with said recess for the engagement and guiding of the wire, and means slidable on the handle to which the ends of the wire are attached operative to partly diminish the size of and move the wire loop relative to the opening in the ovate shaped end.

3. A tonsillotome as claimed in claim 2, wherein the means to partly diminish and move the wire loop relative to the opening in the ovate shaped end comprises a slide mounted on the handle to which the ends of the wire are attached, a spring detent mounted on said meniber normally urged to engage one of a series of notches in the handle to releasably lock the slide against movement on the handle, and means to move and hold said detent out of notch engaging position.

4. In a tonsillotome, a wire looped upon itself intermediate its ends, a handle having at 0D@ end a distal member of ovate shape having a circular opening therein arranged with a recess in the outer portion of the Wall of said opening for engagement of the Wire loop and the inner portion of the Wall of the opening arranged with a cutting edge opposed to and extending in the plane of the recess in the outer portion of the Wall of the opening, and said member having guideways at each side of and within the ovate distal member merging with the recess in the Wall of the opening in the distal member for the engagement of the opposite end portions of the Wire and guiding of the Wire loop, and means to which the opposite ends of the Wire are attached slidable on the handle and operative to partly diminish and draw the Wire loop in the ovate distal member and relative to the cutting edge to compress and extirpate the tonsil and eiect abscission of the tonsil pedicle.

5. In a tonsillotome, a Wire looped upon itself intermediate its ends, a handle having a portion of increased Width at one end terminating at the end in a distal member of ovate shape having a circular opening therein with a recess in the outer portion of the Wall of the opening for the engagement of the Wire loop and the wall of the opening opposed to the recessed Wall portion arranged with a cutting edge, a guide- Way arranged at each opposite side of the portion of the handle of increased Width Within the ovate distal member merging with the recess in the outer Wall of the opening for the engagement and guiding of the Wire at opposite sides of the loop, and means to which the ends of the Wire are attached mounted on the handle and operative to partly diminish and draw the Wire loop transversely of the opening and relative to the cutting edge to compress and extirpate the tonsil and effect abscission of the tonsil pedicle.

6. A tonsillotome as claimed in claim 5, Wherein the face of the handle at the juncture of the ovate distal member with the handle is recessed to form the cutter and the cutter is of concave form in cross section in opposed relation to the convexity of the ovate distal member with the concavity of the cutter diminishing to at form rearwardly from the cutting edge, and the side Walls of said recess being arranged with recesses to guide the Wire loop relative to the cutting edge to co-operate therewith to effect a cleavage of the tonsil.

7. In a tonsillotome, a bar arranged with an arcua e distal portion of ovate form having an opening therein, a cutting edge arranged on the inner portion of the Wall of said opening, a guidev/ay in the outer portion of the Wall of the opening opposite the cutting edge the opposite end portions of which guideway intersect the opposite ends of the cutting edge and eX- tend in a direction toward and terminate at each opposite side of the bar, a member slidably mounted on the bar, means to releasably retain said member against movement on the bar, and

with the opposite end WILLIAM H. IRVINE.

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