Cryogenic device and method for treatment of rhinitis
Devices and methods for more effective cryoablation of a posterior nasal nerve. The cryoablation tip of the device is paddle-shaped, with broad, flat, overall rectangular outline with notches on the sides to create a metacentric outline. One side of the cryoablation tip is conductive, while the opposing side is highly non-conductive. Corner portions of the tip are also non-conductive. Intermediate portions of the side-edge surfaces conductive, and are configured as recesses or notches in the side edge. In use, the system will be inserted into the nasal cavity of a patient, with conductive surfaces of the cryoablation tip disposed in contact with portions of the turbinate lining overlying a posterior nasal nerve, and operated to cool those portions to ablate the posterior nasal nerve. The insulative portion of the cryoablation tip protects remaining surrounding tissue from cryoablation.
1 . A cryoablation system ( 31 ) configured for ablating a posterior nasal nerve ( 11 ) enervating a lateral nasal wall ( 2 ) of a patient, said system comprising a handle portion ( 32 ) and an insertion portion ( 33 ) extending distally from the handle portion ( 32 ), said insertion portion comprising a shaft ( 34 ) having a distal end ( 34 d ) and a proximal end ( 34 p ), with a cryoablation tip ( 35 ) disposed at said distal end of the shaft, and a cryogen reservoir ( 36 ) configured for delivery of cryogen to the cryoablation tip, wherein:
the cryoablation tip ( 35 ) is paddle-shaped, with a broad, flat, overall rectangular outline and a thermally conductive first broad side ( 41 ) and a thermally insulative second broad side ( 42 ), with a first side edge ( 47 ) and a second side edge ( 48 ) between the first broad side and the second broad side and a first notch ( 45 ) in the first side edge ( 47 ),
whereby said cryoablation tip is configured for placement in a nasal cavity of the patient such that:
(1) a proximal portion ( 41 p ) of the thermally conductive first broad side ( 41 ) is configured to be disposed against a first treatment zone ( 16 ) located inferior to a middle turbinate attachment ( 14 ) of a middle turbinate ( 5 ), posterior to an uncinate process ( 15 ) and anterior to a posterior end ( 14 p ) of the middle turbinate attachment ( 14 ); while at the same time,
(2) a distal portion ( 41 d ) of the thermally conductive first broad side ( 41 ) is disposed against a second treatment zone ( 17 ) comprising an area superior to the middle turbinate ( 5 ), and posterior to a posterior end of the middle turbinate, on the lateral nasal wall ( 2 ) of the nasal cavity; while at the same time,
(3) the first notch ( 45 ) is disposed in a third treatment zone comprising a nub ( 9 ) at the posterior end ( 14 p ) of the middle turbinate attachment ( 14 ).
2 . The cryoablation system of claim 1 , wherein the first notch ( 45 ) has a side-edge surface, and the side-edge surface of the first notch ( 45 ) is thermally conductive, and configured to apply cryogenic cooling to the nub.
3 . The cryoablation system of claim 1 , wherein the cryoablation tip further comprises a thermally conductive distally facing surface configured for application to a fourth treatment zone on a front facing surface of the nub at the posterior end of the middle turbinate.
4 . The cryoablation system of claim 1 , further comprising a second notch ( 45 ) in the second side edge ( 48 ).
5 . A method of treating rhinitis in a patient, said method comprising:
providing the cryoablation system of claim 1 ;
inserting the cryoablation tip and the distal end of the insertion portion into the nasal cavity of the patient, and positioning the cryoablation tip such that:
the proximal portion of the thermally conductive first broad side ( 41 ) is disposed against the first treatment zone ( 16 );
the distal portion of the thermally conductive first broad side ( 41 ) is disposed against the second treatment zone ( 17 ); and
the first notch is disposed in the third treatment zone, with the nub ( 9 ) of the posterior attachment of the middle turbinate intruding into the first notch; and
initiating supply of cryogen to the cryoablation tip to simultaneously cryoablate the posterior nasal nerve proximate the first treatment zone and second treatment zone.
6 . The method of claim 5 , wherein:
the first notch ( 45 ) has a side-edge surface, and the side-edge surface of the first notch ( 45 ) is thermally conductive, and configured to apply cryogenic cooling to the nub; and the method further comprises:
locating the cryoablation tip such that the side-edge surface of the first notch ( 45 ) contacts a surface of the nub, whereby initiation of supply of cryogen to the cryoablation tip applies cryogenic cooling to the nub while simultaneously cryoablating the posterior nasal nerve proximate the first treatment zone and second treatment zone.
7 . The method of claim 5 , wherein:
the nub is characterized by an anterior facing surface; and
the cryoablation tip further comprises a thermally conductive distally facing surface configured for application to a fourth treatment zone on the anterior facing surface of the nub at the posterior end of the middle turbinate;
and the method further comprises:
applying the thermally conductive distally facing surface to the anterior facing surface of the nub; and
initiating supply of cryogen to the cryoablation tip to cryoablate the posterior nasal nerve proximate the fourth treatment zone on the anterior facing surface of the nub at the posterior end of the middle turbinate.
8 . The method of claim 5 , wherein:
cryoablation of the first treatment zone or second treatment zone is accomplished without cooling or cryoablating other areas of the lateral nasal wall, a medial surface of the middle turbinate, or an area of a ganglion ( 13 ).
9 . A method of treating rhinitis in a nasal cavity of a patient, said method comprising:
providing a cryoablation system comprising:
a handle portion ( 32 ) and an insertion portion ( 33 ) extending distally from the handle portion ( 32 ), said insertion portion comprising a shaft ( 34 ) having a distal end ( 34 d ) and a proximal end ( 34 p ), with a cryoablation tip ( 35 ) disposed at said distal end of the shaft, and a cryogen reservoir ( 36 ) configured for delivery of cryogen to the cryoablation tip, wherein:
the cryoablation tip ( 35 ) is paddle-shaped, having a thermally conductive first broad side ( 41 ) and a thermally insulative second broad side ( 42 ), whereby said cryoablation tip is configured for placement in the nasal cavity of the patient such that:
(1) the thermally conductive first broad side ( 41 ) is configured to be disposed against a first treatment zone ( 16 ) located inferior to a middle turbinate attachment ( 14 ) of a middle turbinate ( 5 ) of the patient, posterior to an uncinate process ( 15 ) and anterior to a posterior end of the middle turbinate attachment ( 14 ); while at the same time,
(2) the thermally insulative second broad side ( 42 ) may be located proximate a lateral surface of the middle turbinate ( 5 );
inserting the cryoablation tip and distal end of the insertion portion into the nasal cavity of the patient, and positioning the cryoablation tip such that:
the thermally conductive first broad side ( 41 ) is disposed against the first treatment zone ( 16 ) and the thermally insulative second broad side ( 42 ) is facing the lateral surface of the middle turbinate; and
initiating supply of cryogen to the cryoablation tip to cryoablate a posterior nasal nerve proximate the first treatment zone.
10 . A cryoablation system ( 31 ) configured for ablating a posterior nasal nerve ( 11 ) enervating a lateral nasal wall ( 2 ) of a patient, said system comprising a handle portion ( 32 ) and an insertion portion ( 33 ) extending distally from the handle portion ( 32 ), said insertion portion comprising a shaft ( 34 ) having a distal end ( 34 d ) and a proximal end ( 34 p ), with a cryoablation tip ( 35 ) disposed at said distal end of the shaft, and a cryogen reservoir ( 36 ) configured for delivery of cryogen to the cryoablation tip, wherein:
the cryoablation tip ( 35 ) is paddle-shaped, with a broad, flat, overall rectangular outline and a thermally conductive first broad side ( 41 ) with a first broad side proximal portion ( 41 p ) and a first broad side distal portion ( 41 d ) and a thermally insulative second broad side ( 42 ), said cryoablation tip also having a first side edge ( 47 ) and a second side edge ( 48 ) between the first broad side and the second broad side and a first notch ( 45 ) in the first side edge ( 47 ), whereby said cryoablation tip is configured for placement in a nasal cavity of the patient, and wherein said proximal portion ( 41 p ), said distal portion ( 41 d ), and said first notch ( 45 ), are located on the cryoablation tip relative to each other such that the cryoablation tip ( 35 ) is positionable within the nasal cavity, with;
(1) the proximal portion ( 41 p ) of the thermally conductive first broad side ( 41 ) disposed against a first treatment zone ( 16 ) located inferior to a middle turbinate attachment ( 14 ) of a middle turbinate ( 5 ) of the patient, posterior to an uncinate process ( 15 ) and anterior to a posterior end ( 14 p ) of the middle turbinate attachment ( 14 );
(2) the distal portion ( 41 d ) of the thermally conductive first broad side ( 41 ) disposed against a second treatment zone ( 17 ) comprising an area superior to the middle turbinate ( 5 ), and posterior to the posterior end ( 14 p ) of the middle turbinate attachment ( 14 ), on the lateral nasal wall ( 2 ) of the nasal cavity; and
(3) the first notch ( 45 ) disposed in a third treatment zone comprising a nub ( 9 ) at the posterior end ( 14 p ) of the middle turbinate attachment ( 14 ).
11 . A cryoablation system ( 31 ) configured for ablating a posterior nasal nerve ( 11 ) enervating a lateral nasal wall ( 2 ) of a patient, said system comprising a handle portion ( 32 ) and an insertion portion ( 33 ) extending distally from the handle portion ( 32 ), said insertion portion comprising a shaft ( 34 ) having a distal end ( 34 d ) and a proximal end ( 34 p ), with a cryoablation tip ( 35 ) disposed at said distal end of the shaft, and a cryogen reservoir ( 36 ) configured for delivery of cryogen to the cryoablation tip, wherein:
the cryoablation tip ( 35 ) is paddle-shaped, with a broad, flat, overall rectangular outline and a thermally conductive first broad side ( 41 ) with a first broad side proximal portion ( 41 p ) and a first broad side distal portion 41 ( d ) and a thermally insulative second broad side ( 42 ), said cryoablation tip also having a first side edge ( 47 ) and a second side edge ( 48 ) between the first broad side and the second broad side and a first notch ( 45 ) in the first side edge ( 47 ), whereby said cryoablation tip is configured for placement in a nasal cavity of the patient; wherein
the first notch ( 45 ) is configured to receive a nub ( 9 ) of a posterior attachment of a middle turbinate when:
(1) the proximal portion ( 41 p ) of the thermally conductive first broad side ( 41 ) is disposed against a first treatment zone ( 16 ) located inferior to a middle turbinate attachment ( 14 ), posterior to an uncinate process ( 15 ) and anterior to a posterior end of the posterior attachment of the middle turbinate; and, at the same time,
(2) a distal portion ( 41 d ) of the thermally conductive first broad side ( 41 ) is disposed against a second treatment zone ( 17 ) comprising an area superior to the middle turbinate, and posterior to the posterior end of the posterior attachment of the middle turbinate, on the lateral nasal wall ( 2 ) of the nasal cavity.