WO1991013536A2

WO1991013536A2 - Surgical instrument for the accurate osteotomy of the nasal hump

Info

Publication number: WO1991013536A2
Application number: PCT/GR1991/000006
Authority: WO
Inventors: Manolis Diamantis
Original assignee: Manolis Diamantis
Priority date: 1990-12-05
Filing date: 1991-04-19
Publication date: 1991-09-19
Also published as: WO1991013536A3; AU7679691A

Abstract

A surgical instrument for the accurate osteotomy of the nasal hump (Destination Nasion Chisel System: DNCS). DNCS is a stainless metal instrument composed of the driver (1) the chisel (2) and the handle (3). The three components are mounted for the use and demounted for cleaning and sterilization. The driver (1), in spite of lack of visibility of the operating field, facilitates the surgeon to localize exactly the Nasion (N), which is the destination point of the osteotomy. The driver (1) has a mouth (1.1) for the insertion of the chisel (2). The antinasion (1.7) of its bar (1.2) sets on Nasion (N). On its slippery bearing (1.6) and between the wings (1.4) and also the trucks (1.5) moves the chisel (2). The driver also has a socket (1.3) for coupling with the handle (3). The chisel (2), being the cutting component of DNCS, has a distal narrow part (2.4) with a bevel (2.6) and a cutting edge (2.3). This part of the chisel fits the driver (1). The chisel (2) has also a proximal wide part (2.1) with two stops (2.2) and a pole (2.5). The handle (3) with its tongue (3.1) is coupled with the driver (1). Besides, the position of the handle (3) in the space is a guide for the equal in height osteotomy of the nasal bones. Finally, DNCS is an instrument with which the plastic surgeon solves the problem of lack of visibility of the operative field during the rhinoplasty, particularly during the osteotomy of the nasal hump, and is able to perform this, via DNCS, in the most precise way and without danger.

Description

SURGICAL INSTRUMENT FOR ACCURATE OSTEOTOMY OF THE NASAL HUMP (DESTINATION NASION CHISEL SYSTEM : DNCS)

The invention refers to an instrument used in plastic surgery, particularly in rhinoplasty, which accomplishes the most accurate osteotomy of the nasal hump. (Drawing Nr. 5).

The conventional instruments for. the removal of the hump of the nose are mainly chisels, special hand - or motorsaws or rongeurs, At present, with the instruments in use, the inaccurate and wrong osteotomies of the nasal hump are very frequent and the results are various complications and danger for the patients. This inadequacy of the known instruments for the osteotomy of the nasal hump to facilitate the surgeon to accomplish accurate and not dangerous osteotomies, was the motive which pushed me to the invention of DNCS.

For the better understanding of the invention, the causes of the frequency of the inaccurate osteotomies of the nasal hump made via the known instruments are analysed.

It is known that by the aesthetic operation of the nose, particularly by the cut off of the nasal hump, the main problem is that there is not adequate visibility of the operative field.

The visibility, especially, of the NASION is impossible and the exact localisation of it is unrealizable.

But what is NASION ;

NASION is the furthest and deepest point of the dorsum of the nose. (Drawing Nr. 6 : N).

NASION is the most important, permanent landmark for the osteotomy of the nasal hump.

It is the point to which necessarily the osteotomy plane has to be directed and finished, otherwise it is wrong.

Given that NASION is not visible, the surgeon defines the osteotomy plane of the nasal hump and subsequently directs the chisel or any other of the known instruments approximately, according to his subjective criteria only, and on the base of some abstract uncertain momentary estimation.

This is the main cause of the wrong osteotomies of the nasal hump. (Drawing Nr. 6:A,B).

Subsequently, when the surgeon estimates the position of the Nasion higher than the real one, the osteotomy is made high (Drawing Nr. 6: A) and the remaining hump has to be raspeα away.

On the contrary, when the position of the Nasion is estimated lower than it really is, the osteotomy is made low. (Drawing Nr. 6:B). In this case the resulted groove has to be grafted.

On both instances additional work by the surgeon is required and the operative duration is prolonged.

But, there are also cases of both too low and deep osteotomies, once more because of the lack of .visibility and wrong estimation of the exact position of Nasion, that the chisel passing under the Nasion, being pushed in deeply, causing serious damage and or dangerous conditions such as damage of the nasal bones, injury of the front ethmoidal artery with severe hemorrhage, opening of the frontal sinus, injury of the meninges and or injury of the olfactory nerves.

These complications may alsohave another cause, that tne surgeon cannot manage the hammer on his own so that to control exactly the intensity of the blows against the chisel, but his assistant who is less experienced.

However, the most frequent complication of the use of the conventional instruments for the osteotomy of tne hump of tne nose is the injury of the soft tissues of tne nasal dorsum.

All these events or probabilities wnich may nappen by the use of these instruments, are avoided by using tne SURGICAL INSTRUMENT FOR ACCURATE OSTEOTOMY OF THE NASAL HUMP (DESTINATION NASION CHISEL SYSTEM : DNCS) which is the present invention.

Advantages of DNCS.

ACCURACY. The surgeon, by using the DNCS, in spite of lack of visibility, can localise exactly the Nasion. So, he can define with absolute precision the right level of the osteotomy of the hump and at the same time the far point to which the chisel is allowed to reach. Thus any wrong osteotomy is avoided.

Via DNCS the surgeon has the possibility to attend the approaching of the stops of the chisel to the mouth of the driver, controlling exactly the advancement of the edge of the chisel into the base of the hump.

Finally, tne surgeon holding the handle of DNCS parallel witn the imaginary line between the eyes of the patient, succeeds precisely the equal osteotomy of the left and right part of the hump. (Advantage only of tne crosschisel of Robin). EFFECTIVENESS. With DNCS the whole hump is in one piece osteotomised (cut off).

The long beveling of the cutting part of the chisel precludes undesirable fractures of the nasal bones.

SAFETY. The chisel of DNCS is moving in the driver and only as far as the Nasion, which is the obligatory destination of it. So, every complication and dangerous condition, such as injury of the soft tissue, damage of the nasal bones, additive hemorrhage from the injured front ethmoidal artery, opening of the frontal sinus, injury of the meninges or injury of the olfactory nerves are prevented.

With DNCS, the handling of the hammer is undertaken by the surgeon himself.

TIME SAVING. With DNCS, the manipulations for the osteotomy of the nasal hump are cut down to the absolutely necessary ones, so that the duration of tne operation, so valuable for the surgeon and αecisive for the patient, is limited to minimum.

HANDINESS. DNCS is used very easily by right - , or left - handed surgeons.

The handling of DNCS is done only by the one hand of the surgeon so that his other hand is free for managing the hammer.

Object of this invention is a surgical instrument, used in plastic surgery and particularly in aesthetic surgery of the nose, which instrument ensures the accurate osteotomy (cut off) - of the nasal hump.

The DNCS (Destination Nasion Chisel System) is a compound instrument composed of three components : The DRIVER (I). It localises exactly the Nasion (Drawing Nr.6:N).

Defines the osteotomy plane.

Guides the chisel (2).

Stops the chisel (2) on the Nasion (Drawing

6:N).

Protects the tissues from undesirable injuries.

The CHISEL (2). It is the cutting component of DNCS.

It moves in the driver (I).

The HANDLE (3). It is the component for operating the driver (l).

Via the Handle (3), the driver (I) is held and stabilized on the osteotomy plane.

Its position in the space acts as a quide for the equal in height osteotomy of the right and left nasal bones.

The DNCS consists of stainless metal.

DESCRIPTION OF DESTINATION NASION CHISEL SYSTEM (DNCS).

One way of carrying out the invention is described in detail below with reference to drawings which illustrate the elements of it.

The invention is embodied with the DNCS, which is illustrated in perspective view on Drawing I. On this Drawing the instrument is assembled.

Drawing 2 illustrates views and sections of the driver (I) and enumeration of its elements.

Drawing 3 illustrates views of the chisel (2) and enumeration of its elements.

Drawing 4 illustrates the handle (3).

Drawing 5 illustrates the DNCS positioned on the nose, ready for the osteotomy of the hump.

Drawing 6 illustrates wrong osteotomies (A,B) because of inaccurate estimation of the real position of Nasion (N) and the osteotomy line of the hump via the DNCS.

DNCS is composed of the driver (I), the chisel (2) and the handle (3).

The mouth (I.I) is the open side of the driver (I) into which the chisel (2) is inserted.

The bar (I.2) of the driver (I), is arched on the underside. The centre of the arch is called Antinasion (I.7).

The chisel (2) is characterized from a distal narrow part (2.4) and a proximal wide part (2.I).

After the insertion of the chisel (2) into the mouth (I.I) of the driver (I), it slips on the slippery bearing (I.6) and between the trucks (I.5) and the wings (I.4) of tne driver (I), as far as the cutting edge (2.3) arriveεto the bar (I.2) of the- driver (I), particularly to the Antinasion (I.7).

The proximal wide part (2.I) of the chisel (2) is characterised from the stops (2.2) and the pole (2.5).

On the underside of the slippery bearing (I.6) of the driver (I) is located the drivers - socket (I.3) which can be mounted from both sides with the tongue (3.I) of the handle (3).

The drivers - socket (I.3) is characterised from its siαes (I.8) (I.9).

DESCRIPTION OF THE FUNCTION OF DNCS.

The localization of the Nasion is made by two ways a. The Nasion is marked on the skin and a straight needle is verticaly inserted, fixed on the bone. Afterwards, the driver is inserted under the soft tissus of the nasal dorsum so that the arch of the bar (I.2) slips softly on the hump as far as it meets the tip of the needle on the Nasion (Drawing 6:N).

b. The driver (I) is inserted under the soft tissue of the nasal dorsum, slipping on the hump. As far as the arch of the bar (I.2) reaches the root of the nose, delicate back and forth movements are made to lacalize the deepest point of the root which is the Nasion (Drawing 6:N).

After the localization on Nasion (N), which is the most important landmark for the osteotomy of the hump, the driver (I) is held via the handle (3) firmly, so that the arch of the bar (I.2), particularly the Antinasion (I.7) and Nasion (N) coincide.

The chisel (2) is inserted into the mouth (I.I) of the driver (I) and is advanced as far as the cutting edge (2.3) of it comes in contact with the starting point of the osteotomy.

The chisel (2) is held from the driver (I) itself, so that the other hand of the surgeon is free. With this free hand the surgeon holds the hammer and administers gentle blows against the pole (2.5) of the chisel (2) accomplishing the osteotomy.

The surgeon controls the course of tne osteotomy attending the approaching of the stops (2.2) of the chisel (2) to the rims of the mouth (I.I) of the driver (I). So, as soon as the stops (2.2) of the chisel (2) touch the rims of the mouth (I.I) tne osteotomy is finished, because the cutting edge (2.3) of the bevel (2.6) of the chisel (2) simultaneously has arrived to the bar (I.2) of the driver (I), particularly to the Antinasion (I.7) which, as mentioned, coincides with the Nasion (N).

The chisel (2) with the driver (I) have the similar functional relation of the drawer with its drawer - sheath.

Claims

C L A I M S

1. Surgical instrument for the accurate osteotomy of the nasal hump (Destination Nasion Chisel System : DNCS), which is used in plastic surgery, particularly in rhinoplasty.

It ensures the most precise osteotomy (cutting off) of the hump of the nose.

It consists of stainless metal.

It is a compound instrument composed of three components which are mounted for its function and demounted for cleaning and sterilization.

The components of DNCS are the driver (I) the chisel (2) and the handle (3).

The dri ver (I) and the chisel (2) have the functional relation of the drawer - sheath and the drawer.

The internal dimensions of the driver (I) have a precise relationship with these of the distal, narrow part (2.4) of the cnisel (2), so that tney fit eachother.

2. According to the claim I the chisel (2), which is characterized from a distal, narrow part (2.4) and a proximal, wide part (2.I), after its insertion into the moutn (I.I) of the driver (I), slips on the slippery bearing (I.6), between the trucks (I.5) and between the wings (I.4) as well, as far as the cutting edge (2.3) of the bevel (2.6) arrives to the highest point of the arch of the bar (I.2) of the driver (I), which is called Antinasion (I.7).

3. According to the claim 1, the proximal wide part (2.I) of the chisel (2) is characterized from the stops (2.2) and the pole ( 2 .5 ) .

The distal narrow part (2.4) of the chisel (2) ends up to the bevel (2.6) and further to the cutting edge (2.3).

4. According to the claim I, on the undersurface of the slip- pery bearing (I.6) of the driver (I) is the drivers-socket (I.3) for the coupling with the tongue (3.I) of the handle (3). The drivers - socket (I.3) is through so that the tongue (3.I) can be coupled on either the left or right side, according to whether the surgeon is right - or left - handed. The drivers - socket (I.3) is formed from its sides (I.8 and 1.9).

5. According to the claim I, the accurate osteotomy of the nasal hump is accomplished as follows.

The driver (I), held via the handle (3), is inserted through the intranasal incision under the soft tissues of the nasal dorsum and the antinasion (I.7), that is the midpoint of the arch of the bar (I.2) is set on the Nasion (Drawing Nr.5 and Drawing Nr. 6:N). The handle (3) is aαjusted in a parallel position to the imaginary line vvhich connects the eyes of the patient, for the equal in height osteotomy of the left and right nasal bone of the hump. Afterwards the chisel (2) is inserted into the mouth (I.I) of the driver (I) as far as the cutting edge (2.3) touches the desirable starting point of the osteotomy. With his freehand the surgeon manages the hammer and with gentle blows against the pole (2.5) of the chisel (2) accoplishes the osteotomy. As soon as the stops (2.2) of the chisel (2) touch the rims of the mouth (I.I) of the driver (I), the osteotomy of the hump is finished, because simultaneously the cutting edge (2.3) of the chisel (2) arrives to the bar (1.2) of the driver (I), particularly exactly to the antinasion (I.7) which coincides with the Nasion (Drawing Nr.6:N).

6. According to the claim I, the external angles of the driver (I) are rounded.