US 1677337 A
Description (OCR text may contain errors)
T. E. GROVE ANTRUM DRILL Filed Sept l.' 27, 1,924
Patented July 17, 1928n UNVEE STATES.,
' THOMAS EJGROVE, OF- DAYTON, OHIO.
Application filed September 27, `1924-. c Serialv No. 740,314.
' My invention relates .to surgical instru-` ments and more particularly to a drill lfor intianasal opening of the facial sinus or antrum, and thel frontal sinus, aswell as other bone drilling` operations. l
vThe facial sinus or antrum of Highmore is a large cavity of somewhatvpyramidal form, located within the superior maXillary boue. The frontal sinus is an irregular cavity which extends upwardly and outwardly between the tiro tables of the skull, immedi`- ately above the superor'bital varches and communicates with'the nose thru the infundibulum. These cavities are subject to numerous surgical diseases, the most common being infection, followed by suppuration necessitating drainage.
The interior walls of the antrum are comparatively thin, particularly that portion of the interior'wall which separates the antrum from the interior meatus of the `nasal The extreme thinness of the vinternal wall and its accessibility thru the nares renders the intranasal route desirable for surgical operations. However, due to lack of facilities and suitable instruments for puncturing the internal antrum wall, surgical preference has been given to operations by the dental route, which method necessitates the sacrifice by extraction of a molar tooth and the drilling thru the .alveolar process, or the entrance to the antrum thru the lower exterior wall just above the apices of the tooth roots.
rEhe sole means heretofore of lintranasal operations for entrance into the antrum or into the frontall sinus has been by use of a trocar or cannula. The tortuous passage thru the nasal fossae does not readily ac.- cemmodate a straiglrt trocar. A curved trocar or cannula adaptable to the passage is unsuitable since direct driving pressure is necessary and more or less twisting or boringr movement is required to penetrate the antriun wall er enlarge the opening into the fren-tal sinus. In such method there is Ano way of controlling the extent of bone breakage, and the wall may be fractured or splintered thru a greaterjarea Vthan intended. In case the entrance opening thus formed by a pressure operated trocar lis too small the use of a trocar must befollowcd by that of a. rasp.
By the use of the present implement, en,- trancc to tliegantrum thru the nasal route is vachieved by drilling thru the Wall between the antrum and interior meatus, at a point coincident with the bottom of the antrum cavity. Since this point of operai tion cannot be approached `directly on a' straight line' thru the nares, there is employefd an instrument having` an arcuate or curvilinear shaft or cannula provided;
witha burr at its extremity, operated' by drive means extending thru the hollow stem or cannula. y v n ,In prior Patent, No.1`,630,239, there is described a nasal drill having a stem or Can.- nula'of uniform curvature upon a com,- paratively large radius. The drill burr at the extremity of the cannula. in the con-A struction disclosed in such application is driven' by means of a ieXible wire, orfleX-` ible shaft eXtending thru the hollow stem oi' cannula. Allhile theconstruction shown in such earlier Letters Patent isV quite eii cient and practicalv for certain conditions of use, it has been found that a cannula extending substantially straight thruoutthe major portion of its extent and having a rather abrupt lateralbend, adjacent to its extremity whereby the drill burr is disposed ata decided angle with the gener-al extent of the cannula, affords a more practical and reach the preferred point of operation. To
this end, the'pr'esent construction embodies y in lieu of the flexible wire or cable, ysuccessive inflexible driving sections within the hollow cannula, which sections have positive driving interengagement With each other by means of intermeshing teeth on their adjacent extremities. It is frequently desirable to employ a guide or lead element,
which may he. introducedin advancev of the v drill andemployed to probe and locate `the point of operation to which the ldrill burr will be subsequently guided.` To this endV the driving` sections and drill burr are formed with hollow bores coinciding with `each other, thru which may be introduced a silver probe` yor director. Such passage also serves for relief and vdrainage at the Y time of operation.
4The ob]ect of the invention is to simplify' the structure as well as the means and mode of operation of such surgical drill instruments, whereby they will not only be cheaened in construction, but will be more e cient in use, positive in operation, uniform in action and unlikely to get out of repair.
troduction of a director probe or 4"guider n Wire by which` the point of operation may i be definitely located and the drill instrument guided thereto. To this `end the instrumentis provided with 'hollow driving sections for the drill burr, and a hollow burr.
A further object of the invention is to provide a bone drill or the like, the parts of which are easily and readily` accessible for sterilization, but which are so interengag'ed and assembled as to prevent accidental disconnection and loss when in use. l A further object of the invention is to provide an instrument of improved shape and contour to more readily accommodate it `to various sizes of nares and to enable the puncture of the antrum wall at a lower level and also to provide a drill instrument adaptable to the opening of the passage into the frontal sinus, for which the construction shown in Patent No. 1,630,239 heretoforel referred to is not suitable.
With theV above primary and other incidental Yobjects inview as will more fully appear in the specification, the invention consists of the features of construction', the parts and combinations thereof, and the mode of operation or their equivalents .as
v hereinafter described and set fort-h in the claims.
` Referring to the drawings, Fig. 1 is a longitudinal sectional view of the surgical drill forming the subject matter hereof. Fig. 2 is an` enlarged sectional view of the cannula disclosing the driving sections enclosed therein,v and the drill burr at its extremity. Fig. 3. is a modification of the construction kshown in Fig. 2. Fig. 4 is a detailv view ofthe split Abushing for removably securing the rotary drill burr in the end of the cannula. Fig. 5 is a detail View of one of the "driving sections shown inFig. 2. Fig. 6
is a detail viewof the interengagin faces of the driving sections shown in ig. 3.
Fig. 7 is a diagrammatic view showing the relative location of the maxillary `antrum and indicating different directions in which vthe antrum maybe entered, in comparison with the present drill method through the nares.
Like parts areindicated by similar characters of reference thruout the several views. In the drawings, wherein have been shown the preferred, but obviously not necessarily the only forms of embodiment of the invention, the Various parts have been illustrated upon a very much enlarged scale. It will be understood that the lengthV and'diameter of ther cannula and the size of the burr as well as the handle or mounting containing the driving mechanism will be appropriate to the anatomical conditions to which itis ap lied. Y
` n the drawings, 1 is a hollow handle., within which is contained frictional driving mechanism for Vthe Iburr or drill. Dev tachably secured at the extremity of the handle Il by means'of clutch jaws 2` is a hollow cannula or stem To accommodate the instrument to the'nasal passages thru which it must be introduced, the cannula in the present instance is rather abruptly beiit adjacent to its extremity in a lateral direction, inclined to the general axis of the main portion of the cannula, which is substantiallyV straight. The chuck jaws 2 may be of any suitable form or construction. In -the present instance, they consist of a slotted or tapered sleeve carried by the handle section 1 and surrounding the endof the cannula 3. pered collar A1, screw threaded upon the handle section 1. The particular mode of attachment is immaterial, and obviously, other forms of attaching the cannula to the mounting or handle may be substituted. On the outer extremity of the laterally bent or inclined portion of the cannula or hollow stem 3 `is mounted a drill burr 5. vSuch drill burrs are made in various shapes and sizes to meet various conditions of use. For illustrative purposes the drill or burr 5 in the present Yinstance has been shown of sub stantially cylindrical form terminating in a conical or tapered end. This preferred form of drill 4burr is a combineddrill and side mill, by which a hole may not only be drilled thru the antrum wall ory other bony structure, but may be enlarged by side cutting to any desired size. The burr 5 is revolubly mounted in a spit bushing 6, screw threaded in the end of the curvilinear cannula 3. To prevent accidental disengage" ment of the burr, the shank 7 of the burr is provided at its inner end with a head or shoulder S which prevents its withdrawal axially from the bushing 6. T he shank 7 is positioned intermediate the two halves of the split bushing 6 shown in detail in Fig.`
The jaws are contracted by a tallO i igea/gasa `4. This bushing is 'then screwed into the end of the hollow stem or cannula 3. The bushing is threaded right or left according tothe direction of rotation of the burr, so that it is screwed intov the-cannula in the same direction that the burr rotates. Thus the tendency of the rotating drill or burr will be toV tighten the split bushing 6 in place. Obviously, when the shank of the burr is enclosed Within the split bushing 6 with the shoulder or head 8 at one end, and the drill head at the other end, it cannot become dislodged or accidentally disconnected and lost intthe antrum cavity or in the nasalfossae.
The terminal face of the spindle head18is provided with a series of radially disposed spaced lugs or teeth, resembling clutch teeth rather than gear teeth. The teeth 9 of the head 8 engage with corresponding teeth or lugs 10upon a short driving section 11 located within the cannula. This drivingsection 11 ismedially reduced at 12,v the extremities of the section bearing teeth 10 being -f formed into spherical heads 13. Any number of such sections may be provided as may be'necessitated by the extent of the bend or arcuate configuration of the cannula. In the present instance there are two such intermediate short driving sections 11, each having at its opposite ends terminal clutch teeth or driving lugs 10. The diameters of the spherical heads 13 at the opposite ends ofv the sections v11 corresponding with the internal diameter of the cannula enables'the driving sections 11 to accommodate themselves to the curvature of the cannula and to freely rotate therein. Extending thru the major straight portion of the cannula is a revoluble stem or shaft 14, having a its .extremity clutch teeth or driving lugs 15, interengaging with the driving lugs or teeth 10 of the first short section 11 ofthe series. This drive shaft or spindle 14 may be provided with a polygonal terminal at its Avopposite end for direct engagement with the main drive shaft ofthe mounting .or transmission mechanism is shown in Fig. 3. However, to accommodate a lead wire or guideI probe, the spindle 14 and intermediate driving `sections 11, aswell as the burr or drill areprovided with registering longitudinal bores 16, 17 andV 18 respectively, thru which such guide wire or lead may be introduced and projected beyond the extremity of thendrill or burr. vThe intercommnnicating bores 1G, 17 and 18 form a vent or drain passage during theperiod of operation. In order that the entrance orifice of such passage may be unobstructed for the introduction and manipulation of the probe or lead wire the spindle 14 is connected in offset relation with the power transmission devices enclosed in the handle 1. To this end the spindle 14 isprovided at its extremity with a gear pinion 19, meshing with acorresponding gear pinion 20on a stub shaft 21. rThese gear pinions are enclosed within av housing or coupling enclosure 22, having therein a bearing for the stub shaft 21. The stub shaft 21 is provided with the polygonalv extremity 23 engageable with the main shaft of the power transmission mechanism.
As before mentioned the power transmission mechanism is enclosed within the hollow handle 1. The polygonal extremity 23 of thel stub shaft 21 is received in a corresponding socket in the end 'of the drive shaft 24-` This shaft 24 extends axially within the handle section 1, and is provided with a bearing in a lug 25, in one end of the handle mountsrk ing, and has a loose journal bearing` in the Y inner end of the clutch sleeve 2 at the opposite end of the handle section. Fixedly secured to the drive shaft 24 is a friction drive collar26, adjacent to which are loosely Vjournaled upon the drive shaft two driving gears 27 spaced apart and between'which is interposed a friction drive disc 28. The disc 28 is keyed upon the shaft 24 for unison rotation therewith, and is free for axial adjustment. Bearing upon the gear 27 on the side opposite the fixed collar 26 is a second friction collar 29, also keyed upon the shaft 24 for unison rotation, but slidingly adjustable in an axial direction and exerting pressure upon the gears 27, under the influence of a spring 30. The spring 30 is of helical formation, bearing at one end upon the sliding' friction collar 29, and abutting upon its opposite end upon a stop nut 31, adjustable upon the shaft 24 to vary the tension of the spring and secured in its adjusted posi-. tion by means of the lock nut 32. The construction is such. that while the gears 27 are loosely journalled upon the shaft 24 for independent rotation they are clamped between the friction collar 26 and 29, and the interposed friction discs 28, under spring pressure to afford the `necessary driving power. The gears 27 intermesh with a driving gear pinion 33` upon a counter shaft `34 Asuitably journalled in the handle'section 1` in parallel relation with the maindrive shaft. 24, and extending beyond the handle section where it is connected to a driving motor or other suitable source of power. The frictional engagement ofthe collar 26, 28 and 29 with the driving gear 27 is sufficient to drive the shaft 24 and vwith 'it the burr or Y drill 5 in anyordinary operation. However, should the resistance to the burr or drill be- SIU lll() ies lll)
come suiiiciently great to endanger either i the patient or the instrument or to be such as to be likely to cause breakage of the burr,
gaged from the Vhandle and with it the intermediate driving connection between the main l burr and the spindle 14 can then be removed thruthe end of the cannula. The coupling or housing 22 is provided with a removable bushing 36, and a removable head 85, which upon disengagement permit the withdrawal of thestub shaft 21 with its gear pinion 2O andthe spindle 14 with its gear pinion 19. The head is provided with a central oriiice registering with the bore 16 of the spindle 14, thru which the lead wire or guide probe may be introduced.
In `the event'that a guide or lead wire is not to be employed and the registering bores thru the spindle and burr are to be omitted,
the spindle is directly connected with theY power shaft ot the transh'tting mechanism by means of a polygonal head Q3, 'forn'ied directly upon the extremity oi the spindle as shown in Fig. 3. In theV event that the curvature or lateral defiection oit the cannula is abrupt, so that intermediate driving sections 11 are unnecessary toaccoinniodate the power transmission devices to the larva-- ture of the cannulathe extremity oit tliespindle may have direct driving engagement with the burr or drill Vas aise shown in L In this figure the spindle lei is Aformed with' a series of radial teeth on its terminal face. The head 8 of the burr or shank is :termed with similar teeth intermeshing with those ot the spindle. By this means power is transmitted directly from the spindle 14 to the shank of the drill burr, whereas in the construction shown in Fig. 2 because ot the more extended curvature of the'cannula, making direct connection of the spindle and burr impossible, the intermediate `short driving sections 11 arel interposed, which sections because of their spherical heads at each end .readily accommodate themselves to the cui yature of the cannula and freely rotate there- In Fig. 3 a bushing 37 at'the end of the cannula opposite the burr forms a bearing for the spindle 14 and removably secures the spindle within the cannula. The bushing 6 at one endof the cannula and bushing 37 at the opposite end thereof are reversely threaded, one being right hand and one being left hand threaded, the threading agreeing in direction with that ot theV rotation oi' the spindle and burr, Vso that the tendency of such rotation will be to tighten both busliings, thereby entirely obviating any tend- In the diagrammatic view, Fig.f7, the application of the present instrument to antrum purposes has beenillustrated. ABy
its use the entrance orifice may be approximately at the bottomv of thenasal fessee and larged Vand extendedas desired. If the bone Y is dense or hard there is no danger otfracture las sometimes occurs under Athe heavypressure required'to force a trocar thru Vthe wall. Moreover, the use of the rasp forl the enlargement of the opening is eliminated.
In FiO. 7 external routes as resent em- 1 :D n ployeu are indicated at 40' and 41 respectively. Obviously, the route Ai() vnecessitates the sacrilice of a molar tooth in order to enter `the antrum. l
It is obvious that the instrument herein snown and? described may be applied to many other bone drilling operations, as will readily occur to the skilled surgeon. For dil'l'erent purposes the cannula carrying the burr may be made or various degrees of curvature or ott lgreater or less length. To meet unex- ,ected or unusual conditions for emergency operations, the tubular stein or cannula may be made oit material capable of being flexed or bent into va ious shapes at the time of its use te enable operations in otherwise inaccessible locations.A Obviously, such curvatures of the cannula would be readily .per-v mitted by the employment of a succession of short driving sections 11. rIhe instrument adaptable to dental drilling operations or surgery for which vpurpose a variety o'l interchangeable cannul or tubular stems of di'tierent extent and curvature willbe pro-l vided. The advantage of they instrument for intranasal operations is illustrated in Fig'. 7, wherein the thicker portion of the internal wall of the antrum is shown being penetrated at a much lower level than is possible with the use of a nasal trocar. Inusing the trocar the surgeon necessarily selects the higher and thinner walled area 39L as the point of entrance, with sacrifice of drainage r'acilitiesbecanse of its accessibility and the impossibility of forcing the trocar thru the thick lower wall. y y
F rom the above description it will be apparent that there is thus provided a device of the character describedy possessing the particular features'of advantage before enumerated as desirable, but which obviously is sus-4 ceptible o't' inoditicationin its form, proportions, detail construction and arrangement of parts without departing from the principle involved or saeriiicing any of its adv'antages.
I'Vhile in order to comply with the statute the invention has been described in language more or less specilic as to structural features vit is to be understood that the invention is till closed comprises the preferred form `of several `modes of putting the invention' into effect and tlie invention is, therefore, claimed in any of its forms or modifications within the legitimate and valid scope ofthe appended claims. Y y
Having thusv described my invention, l claim:
l. In a surgical drill for entering the maxillary antrum through the nares or the like, the combination with a mounting including a .revoluble drive shaft, of a tubular cannula laterally `bent-.adjacent to-its extremity, a revoluble cutting burr mounted in` the end of the bent portion of the cannula., the cannula being shaped and proportioned, to follow thebuir into any ypassage traversed by such` burr, a shank I for said burr, a head on the inner end of the shank having a plurality of radially vdis-l posed teeth, a spindle revolubly mounted in the cannula with its axis angularly disposed in relation with that of the bur-r, said `spindle having at its extremity teeth operatively connected with those of theburr, the
other end of the spindle being operatively engageable with the power shaft of the mounting.
2. In asurgical drill, the combination l with a mounting including a revoluble power shaft, of a tubular `cannula of curvilinear form, a revoluble drill burr mounted at the extremity of the cannula, the cannula being so shaped and proportioned toenable its entrance into the passage traversed by said burr and means for operatively connecting the burr with the power shaft thru the interior of the cannula including a succession of independent power transmission sections arranged end to end within the cannula, successive sections of the series being arranged with their axes inclined to each other. y y
3. In a surgical instrument, a cannula comprising two angularly disposed portions, a revoluble cutter `mounted at the extremity of the cannula which is Vshaped and proportioned to follow the cutter into arestricted passage traversed by the cutter', a positive driving connection extending thru the in* terior ofthe cannula including a succession of inflexible sections having intermeshing terminal teeth, and means for rotating such sections. i
4e. In a surgical instrument, a tubular stem bent at a mid-length point to aiford a 'sub stantially straight portion, and a portion inclined thereto of substantially `uniform diameter throughout, a drill burr revolubly mounted at the extremity of the inclined portion'and at least as great in diameter as that of the tubular stem, driving means for the drill burr located within the tubular stein and means for rotating `the drivingv HIGHDS.
tion of a guidewire.
5. Infa surgical instrumentf the character described, atubular stein, comprising two lsubstantially straight relatively inclined `portions joined by an intermediate bend, revoluble cutter at the extremity of vone of said ,portions capable of providing` an orifice through which the adjacentportions of the tubular stem may be projected, an actuating mechanism at the Yend of the other portion, andan intermediate driving connection ex,- tending thru the interior of the ytubular stem from the actuating mechanism to the cutter. f
6. In a surgical instrument, tubular stem,` a cutter mounted upon the extremity of said stem, said stem being shaped and proportioned to follow said cutter into .a restricted passage, a succession of intergeared driving elements extending' thru the interior of the tubular stem' andtransm'itting motion positively to said cutter, andv an actuating mechanism for4 said driving elements connected to the other-end of said .andcutter coinciding vone with the other to form a continuous tion of a lead wire.
8.' In a surgical instrument, a hollow'drill passage for the introducburr, a stem on which the burris carried, Y
hollow Idriving elements forl the `drill yburr wit-hin the tubular stem, Vthe passages thru the drill -burr and driving elements affording .a continuous passage for the 4introduc- 9. In a surgical instrument, a revoluble cutter havingk an axial passage theretliru, a drive'. shaft for said cutter Aalso having an axial` passage therethru and a lead wire introducible thru the said passages to a point Vbeyond said cutter as aguidefor the advance movement of the cutter, 'and means for actuating thedrive shaft.
10. In a surgical instrument, abent tub- 1 ular stem, a cutter revolubly mounted upon the end of saidistem, actuating mechanism. a driving connection between the actuatingV mechanism andy the cutterA extending thruv the interior of thev tubular stem, and a guide adjustably projected-beyond the cutter.
ll. Ina surgical drill., a revoluble hollow izo'y cutter, a bentptubularfstem at 'one-gend of which the cutter is revolubly mounted, a
hollow drive rshaft'extending/thru thefbent tubularstem, the ,passage of said drive shaft .comnruni'cating with that of the hollow cutwhich the cutter is revolubly mounted, a series of clutch teeth upon the inner end of the cutter, a drive shaft extending within kthe tubular Stem, having upon its extremity a plurality of clutch teeth, and a plurality of intermediate clutch elements each comprising an intermediate cylindrical portion of less diameter than the interior diameter of the tubular stem and integral terminal heads of spherical form having diameters substantially equal to the interior diameter of the stem and comprising the bearing surfaces upon which said clutch elements rotate within the stem, said clutch elements having clutch teeth formed on their extremities ofV reducedthickness, the spherical heads being intersected to forma successionof clutch teethat each end ofk the drivingelement, driving and driven elements at opposite ends of Such driving element with which the clutch teeth interengage totransmit motion thru an vunalined portion of the tubular stem to the cutter, `and means for driving said elements.
14. In a sur ical instrument of the character described, a cannula, 'a cutting burr mounted at one end thereof, the cannula being lshaped and proportioned to follow the cutter into a restrietedoriice formed thereby, means for rotating the cutting burr, and
a handle'portion connected in angular relation to the cannula whereby the end of the cannula opposite the euttingburr is open for access through the cannula to'the areav of operation of thefburr.
15. In aV surgical instrument of the character described, a cannula, a cuttercarried at one end thereof, the cannula being shaped and proportioned to follow the cutter into a restricted orifice formed thereby, and driv- Y Ving means for the cutter connected in odset relation with the cannula wherebyaccessis permitted to the endof the cannul'a'opposite thev cutter and .thence through said cannula to the area of operationof the cutter. Y 16. In a surgicalinstrument of the character described, a cannula, a cutter 'carried at the end thereof capable of forming an opening to receive fthepcannula, means for driving the cutter, the Aend of the cannula 'opposite the cutter being accessible for communication throughvr the cannula with the area of operation of the cutter.
17. As an article of manufacture a drill burr including a shank having/therein a peripheral groove forming a trunnion upon which the burr rotates and spaced shoulders defining the peripheral groove, said burr having an axial bore extending therethrough and open at its opposite ends.
' 18. In a surgical instrument, a cannula, a hollow cutter mounted at the 'end of the cannulal and capable of forming an opening into which the cannula will follow, the hollow interior of the cutter communicating with the interior of the cannula to affordal continuous passage through the cannula terminal cuttingv face, including a shank A having therein a peripheral groove forming a trunnion upon which the cutter vrotates and spaced shoulders defining the 'peripheral groove.`
20. As an article of manufacture a cutter having a cylindrical cutting face andV a terminal cutting face, including a shank having therein a peripheral groove forming a trunnionr upon which the cutter rotates and spaced shoulders defining the peripheral groove, said cutter having an axial opening ltherethrough from one end to the` other.
21. In a drill of the character described,4
a revoluble burr, a mounting therefor, a drive shaft operatively connected'withthe burr, a drive gear loosely journaled on the drive'sh-aft, a pair of spaced collars one of which is fixediy secured upon the drive shaft, the other of which is axially adjustable thereon but engaged therewith for unison rotation, and between which the gear is mounted, and a spring urging themovable collar toward the fixed collar to yieldingly clamp t-he drive gear therebetween.
' 22. In a. drill of the character described, a revoluble burr, a mounting therefor, a drive shaft operatively connecte-d with the burr, a counter shaft, intermeshing gears operatively connecting the drive shaft and countershaft one with the other, one of said gears being loosely mounted on its shaft, and friction discs on opposite sides of the loosely 'mounted gear, mounted for rota-tion with the shaft and yieldingly engagingthe shaft under spring pressure.
In testimony whereof, vI have hereunto setY my hand this 23rd day of September, A. D. 1924. V Y THOMAS E. GROVE. Y'