Apparatus and method for treating rhinitis
Devices and methods for treating rhinitis are described where the devices are configured to ablate a single nerve branch or multiple nerve branches of the posterior nasal nerves located within the nasal cavity. A surgical probe may be inserted into the sub-mucosal space of a lateral nasal wall and advanced towards a posterior nasal nerve associated with a middle nasal turbinate or an inferior nasal turbinate into a position proximate to the posterior nasal nerve where neuroablation of the posterior nasal nerve may be performed with the surgical probe. The probe device may utilize a visible light beacon that provides trans-illumination of the sub-mucosal tissue or an expandable structure disposed in the vicinity of the distal end of the probe shaft to enable the surgeon to visualize the sub-mucosal position of the distal end of the surgical probe from inside the nasal cavity using, e.g., an endoscope.
1. A method for treating rhinitis of a patient, the method comprising:
bluntly dissecting with a distal end of a surgical probe along a surgical plane into a sub-mucosal space of a lateral nasal wall within a nasal cavity of a patient, the surgical probe comprising a surgical probe shaft with a proximal end and the distal end, a handle coupled to the proximal end, and a cryotherapy element disposed on the distal end;
advancing the distal end of the surgical probe shaft within the sub-mucosal space of the lateral nasal wall tissue and towards at least one nasal nerve associated with the lateral nasal wall tissue; and
cryogenically treating the at least one nasal nerve with the cryotherapy element to reduce at least one symptom of rhinitis.
2. The method of claim 1 , wherein the distal end of the surgical probe shaft comprises a flexible segment and bluntly dissecting comprises flexibly bending the distal end of the surgical probe shaft to laterally traverse the distal end of the surgical probe shaft along the surgical plane.
3. The method of claim 1 , wherein bluntly dissecting comprises inserting the distal end of the surgical probe into the sub-mucosal space at a position substantially anterior to a middle nasal turbinate or an inferior nasal turbinate of the patient.
4. The method of claim 3 , further comprising advancing the distal end of the surgical probe towards a target posterior nasal nerve along the surgical plane.
5. The method of claim 1 , wherein bluntly dissecting comprises inserting the distal end of the surgical probe into the sub-mucosal space substantially between a middle nasal turbinate and an inferior nasal turbinate of the patient.
6. The method of claim 1 , wherein bluntly dissecting comprises inserting the distal end of the surgical probe into the sub-mucosal space in a vicinity of a cul de sac defined by a tail of a middle nasal turbinate, lateral nasal wall, and inferior nasal turbinate of the patient.
7. The method of claim 1 , wherein the surgical plane is defined by a bone of the lateral nasal wall and overlying nasal mucosa and bluntly dissecting comprises inserting the distal end of the surgical probe shaft into the sub-mucosal space at a position proximate of the at least one nasal nerve along the surgical plane.
8. The method of claim 1 , further comprising visually tracking a position of the distal end of the surgical probe shaft with a position indicator while advancing the distal end of the surgical probe shaft within the lateral nasal wall tissue.
9. The method of claim 8 , wherein the position indicator comprises an optical beacon, and wherein visually tracking the position of the distal end of the probe shaft comprises trans-illuminating the optical beacon through mucosa.
10. The method of claim 8 , wherein the position indicator comprises an expandable structure, and wherein visually tracking the position of the distal end of the probe shaft comprises expanding the expandable structure so as to displace mucosal tissue overlying the distal end of the surgical probe shaft.
11. The method of claim 1 , wherein cryogenically treating the at least one nasal nerve comprises delivering a cryogenic fluid into the cryotherapy element from a cryogenic fluid source fluidly coupled to the cryotherapy element.
12. The method of claim 11 , wherein the cryotherapy element comprises an expandable structure, wherein the expandable structure is configured to transition from a deflated configuration to an inflated configuration upon evaporation of the cryogenic fluid within the expandable structure.
13. The method of claim 11 , wherein the cryotherapy element comprises a distal aperture of a fluid channel configured for sub-mucosal delivery of a cryogenic fluid.
14. The method of claim 1 , wherein the cryotherapy element comprises a planar structure.
15. The method of claim 1 , further comprising sensing arterial or venous blood flow within the lateral nasal wall to avoid damage to an artery or vein associated with the at least one nasal nerve.
16. The method of claim 15 , wherein sensing is carried out a by ultrasonic or optical sensor.
17. The method of claim 15 , wherein the artery or vein associated with the at least one nasal nerve comprises a sphenopalatine artery or vein.
18. The method of claim 1 , wherein cryogenically treating the at least one nasal nerve comprises ablating a surrounding region of tissue to a depth of 50-1000 microns.
19. The method of claim 1 , wherein cryogenically treating the at least one nasal nerve comprises ablating a posterior nasal nerve or branches thereof.
20. The method of claim 1 , wherein cryogenically treating the at least one nasal nerve comprises ablating a parasympathetic nerve, a palatine nerve, or a maxillary nerve.