Improvements in endoscopic bite blocks

Abstract

An endoscopic bite block including a body with a bite barrier portion to be located between the upper and lower teeth of a patient when the bite block is in a fitted position, the body having a passage therethrough for insertion of an endoscope, the passage extending between an opening at a first end of the body and an opening at a second end of the body, and in the fitted position of the bite block, the first end is located behind the teeth of the patient and the second end is located in front of the teeth of the patient; and a retaining means configurable between a fitting position or configuration, which facilitates fitting of the bite block into the fitted position, and a retaining position or configuration, which facilitates retainment of the bite block in the fitted position.

Description

IMPROVEMENTS IN ENDOSCOPIC BITE BLOCKSField of the invention

[0001] The present invention relates to the endoscopic bite blocks and related components for use during procedures wherein an endoscope, such as a gastroscope or bronchoscope, is inserted in the mouth of patient, and assemblies and methods including same.Background of the invention

[0002] The reference in this specification to any prior publication (or information derived from it), or to any matter which is known, is not, and should not be taken as, an acknowledgement or admission or any form of suggestion that that prior publication (or information derived from it) or known matter forms part of the common general knowledge in the field of endeavour to which this specification relates.

[0003] Endoscopes are used to provide imagery of internal body cavities and organs. They comprise cameras mounted at the end of elongate tubing that is inserted into a natural orifice or surgical opening. Captured image data is transmitted through wires in the tubing back to a real-time display or to computer storage for later viewing. There are variety of forms of endoscope, with the functionally and properties varying according to the site of insertion and clinical investigation required. In some cases, such as for a gastroscopy or bronchoscopy, endoscopes are inserted into the mouth.

[0004] Patients undergoing endoscopic investigation via the mouth are usually anesthetised, and the endoscope is fed through a bite block placed between their teeth, to stop them inadvertently biting down on the endoscope. Biting the endoscope can cause damage to the patient’s teeth and also damage the endoscope.

[0005] These bite blocks typically comprise a bite barrier portion that sits between the patient’s teeth, and a front frame that rests over the patient’s lips. To assist with secure fitting of the bite block, an elasticized strap is typically connected to the frame and extended around the patient’s head (see e.g. Figure 1 ).

[0006] Endoscopic investigations via the mouth face several issues. Firstly, secure positioning of the bite block with the elasticized strap is sometimes not effective, allowingthe bite block to move out from between the patient’s teeth. This leaves the endoscope exposed to damage if the patient bites down on it. Secondly, the nature of these procedures requires the mouth to be kept open. When the mouth is open, air is drawn in through the mouth when the patient inhales, rather than through the nose, due to the increased resistance in the nasal cavity. It will be appreciated that during these procedures there are significant airway obstructions in the oral cavity, such as the endoscope etc, which may be exacerbated by the position of the head and neck. Other factors may also contribute to obstruction, such as, for example, pre-existing sleep apnoea, where the tongue may fall toward the pharyngeal wall or palate, or the patient may have a large tongue. Such factors / obstructions can lead to reduced oxygen intake by the patient which is compounded by the already reduced tidal volume caused by the anaesthesia. As a result, there is an increased risk of hypoxia in patients undergoing these mouth entry endoscopic procedures.Summary of the invention

[0007] According to one aspect, embodiments are disclosed of an endoscopic bite block including: a body with a bite barrier portion to be located between the upper and lower teeth of a patient when the bite block is in a fitted position, the body having a passage therethrough for insertion of an endoscope, the passage extending between an opening at a first end of the body and an opening at a second end of the body, and in the fitted position of the bite block, the first end is located behind the teeth of the patient and the second end is located in front of the teeth of the patient; and a retaining means configurable between a fitting position or configuration, which facilitates fitting of the bite block into the fitted position, and a retaining position or configuration, which facilitates retainment of the bite block in the fitted position.

[0008] In certain embodiments, the retaining means is a retaining member that is coupled to the body such that it can rotate with respect to the body, between fitting and retaining positions.

[0009] In certain embodiments, the retaining member provides an anchor portion at the first end of the body.

[0010] In certain embodiments, the anchor portion is in the form of an elongate element.

[0011] In certain embodiments, the elongate element has two ends which each extend laterally with respect to the direction from the first end to the second end of the body, in generally opposite directions.

[0012] In certain embodiments, the ends of the elongate element are curved in a direction away from the body.

[0013] In certain embodiments, the ends of the elongate element provide tab portions.

[0014] In certain embodiments, the passage includes a partition therein and / or end closure, the partition and / or end closure having an expandable opening for receiving the endoscope therethrough, so as to provide a substantial seal around the endoscope when inserted.

[0015] In certain embodiments, the passage includes a partition therein and / or end closure, the partition and / or end closure configured to be openable to allow for insertion of the endoscope through the passage, and also configured to close once the endoscope is removed.

[0016] In certain embodiments, the partition and / or end closure provides a substantially seal around the endoscope when inserted.

[0017] In certain embodiments, the passage is substantially cylindrical.

[0018] In certain embodiments, the retaining member includes a substantially tubular portion, the tubular portion fitted concentrically within the passage such that it can rotate therewithin.

[0019] In certain embodiments, an inner wall surface of the passage and an outer wall surface of the tubular portion have cooperating formations thereon that prohibit overrotation of the retaining member beyond the fitting and retaining positions.

[0020] In certain embodiments, the body further includes a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position.

[0021] In certain embodiments, the wall portion is shaped to provide a sealing effect with respect to the mouth opening of the patient.

[0022] In certain embodiments, with respect to the direction from the first end of the body to the second end of the body, the wall portion extends laterally from the bite barrier portion at the second end of the body.

[0023] In certain embodiments, the wall portion is substantially U or C-shaped, providing opposing arms, the arms extending initially laterally from the bite barrier portion at the second end of the body and then in the direction of the first end of the body.

[0024] In certain embodiments, one of the arms includes an aperture therein.

[0025] In certain embodiments, the wall portion includes main faces that are solid apart from the aperture.

[0026] In certain embodiments, the bite block includes a connector at the aperture.

[0027] In certain embodiments, the connector is a tubular extension that extends from a rim of the aperture.

[0028] In certain embodiments, in the fitting position of the retaining member, the elongate element has a direction of elongation that is in the plane of the opposing arms of the wall portion, and in the retaining position of the retaining member, the elongate element has a direction of elongation that is angled with respect to the plane of the opposing arms of the wall portion.

[0029] In certain embodiments, in the retaining position of the retaining member, the elongate element has a direction of elongation that is substantially perpendicular to the plane of the opposing arms of the wall portion.

[0030] In certain embodiments, with respect to a fitted position of the bite block, when the retaining member is in the fitting position the elongate element has a direction of elongation that is parallel to the transverse plane of the patient, and when the retaining member is in the retaining position the elongate element has a direction of elongation that is perpendicular to the transverse plane of the patient.

[0031] In certain embodiments, the bite barrier portion includes substantially parallel top and bottom outer biting surfaces.

[0032] In certain embodiments, the retaining member includes a handle portion that extends from the tubular portion at the second end of the body and outside the passage.

[0033] In certain embodiments, the bite block includes a funnel at the second end of the body to guide insertion of an endoscope into the passage opening at the second end of the body.

[0034] In certain embodiments, the funnel is part of a funnel member.

[0035] In certain embodiments, the funnel member includes a tubular portion that is concentrically fitted within the tubular portion of the retaining member.

[0036] In certain embodiments, the funnel member includes an aperture in a wall thereof.

[0037] In certain embodiments, the funnel member includes a neck region that protrudes from the second end of the body.

[0038] In certain embodiments, the aperture in the wall of the funnel member is disposed at the neck region of the funnel member.

[0039] In certain embodiments, the funnel member includes a connector at the aperture in the wall of the funnel member.

[0040] In certain embodiments, the connector is a tubular extension that extends from a rim of the aperture in the wall of the funnel member.

[0041] In certain embodiments, the retaining means includes at least one arm movable between a retracted position and a deployed position, wherein the retracted position provides the fitting position or configuration, and the deployed position provides the retaining position or configuration.

[0042] In certain embodiments, in the retracted position, the at least one arm extends into the passage.

[0043] In certain embodiments, the at least one arm is biased to the retracted position.

[0044] In certain embodiments, the at least one arm is provided by a tongue formed in a wall of the passage.

[0045] In certain embodiments, in the deployed position, at least a portion of the at least one arm extends outward from body.

[0046] In certain embodiments, the bite barrier portion provides upper and lower outer biting surfaces, and the at least one arm is formed in the upper and / or lower outer biting surfaces.

[0047] In certain embodiments, the at least one arm is bent at a free end thereof, to provide a region of the at least one arm that protrudes with respect to the upper and lower outer biting surfaces when the at least one arm is in the deployed position, the remainder of the at least one arm sitting substantially flush with the upper and / or lower biting surfaces.

[0048] In certain embodiments, the at least one arm is two arms.

[0049] In certain embodiments, the bite block includes an insert to be received in the passage such that when inserted, the at least one arm is maintained in the deployed position.

[0050] In certain embodiments, the insert is an endoscope guide.

[0051] In certain embodiments, the insert is elongate and tubular.

[0052] In certain embodiments, the insert includes a tailing end that protrudes from a second end of the body when inserted therein.

[0053] In certain embodiments, the insert has a funnel at the tailing end, to guide insertion of an endoscope.

[0054] In certain embodiments, the insert includes an aperture in a side wall of the tailing end.

[0055] In certain embodiments, the insert includes a connector at the aperture in the side wall of the tailing end.

[0056] In certain embodiments, the connector is a tubular extension that extends from a rim of the aperture.

[0057] In certain embodiments, the insert includes a leading end that protrudes from the first end of the body when inserted therein.

[0058] In certain embodiments, the insert is substantially straight along its length.

[0059] In certain embodiments, the leading end opens to the side with respect to the longitudinal axis of the insert.

[0060] In certain embodiments, the insert includes a partition therein and / or end closure, the partition and / or end closure having an expandable opening for receiving the endoscope therethrough, so as to provide a substantial seal around the endoscope when inserted.

[0061] In certain embodiments, the insert includes a partition therein and / or end closure, the partition and / or end closure configured to be openable to allow for insertion of the endoscope therethrough, and also configured to close once the endoscope is removed.

[0062] In certain embodiments, the partition and / or end closure provides a substantial seal around the endoscope when inserted.

[0063] In certain embodiments, the passage is substantially cylindrical and the insert when inserted is fitted concentrically within the passage such that it can rotate therewithin.

[0064] In certain embodiments, the body and the insert each have cooperating formations that limit rotation of the insert when inserted in the body.

[0065] In certain embodiments, the body further includes a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position.

[0066] In certain embodiments, the wall portion is shaped to provide a sealing effect with respect to the mouth opening of the patient.

[0067] In certain embodiments, with respect to the direction from the first end of the body to the second end of the body, the wall portion extends laterally from the bite barrier portion at the second end of the body.

[0068] In certain embodiments, wherein the wall portion is substantially U or C- shaped, providing opposing arms, the opposing arms extending initially laterally from the bite barrier portion at the second end of the body and then in the direction of the first end of the body.

[0069] According to a further aspect, embodiments are disclosed of an endoscopic bite block including a body with a bite barrier portion to be located between the upper and lower teeth of a patient when the bite block is in a fitted position, the body having a passage therethrough for insertion of an endoscope, wherein the passage extends between an opening at a first end of the body and an opening at a second end of the body, and in the fitted position of the bite block, the first end is located behind the teeth of the patient and the second end is located in front of the teeth of the patient, the body further including a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position.

[0070] In certain embodiments, the wall portion is shaped to provide a seal effect with respect to the mouth opening of the patient.

[0071] In certain embodiments, the wall portion includes an aperture therein.

[0072] In certain embodiments, the wall portion includes main faces that are solid apart from the aperture.

[0073] In certain embodiments, the bite block includes a connector at the aperture.

[0074] In certain embodiments, the connector is a tubular extension that extends from a rim of the aperture.

[0075] In certain embodiments, with respect to the direction from the first end of the body to the second end of the body, the wall portion extends laterally from the bite barrier portion at the second end of the body.

[0076] In certain embodiments, the wall portion is substantially U or C-shaped providing opposing arms, the arms extending initially laterally from the bite barrier at the second end of the body, and then in the direction of the first end of the body.

[0077] In certain embodiments, one of the arms includes the aperture therein.

[0078] In certain embodiments, the bite block includes a funnel at the second end of the body to guide insertion of an endoscope into the passage opening at the second end of the body.

[0079] In certain embodiments, the funnel is part of a funnel member that is fitted to the body.

[0080] In certain embodiments, the funnel member includes a tubular portion that is concentrically fitted within the passage.

[0081] In certain embodiments, the funnel includes an aperture in a wall thereof.

[0082] In certain embodiments, the funnel includes a neck region that protrudes from the second end of the body.

[0083] In certain embodiments, the aperture in the wall of the funnel member is disposed at the neck region of the funnel member.

[0084] In certain embodiments, the funnel member includes a connector at the aperture in the wall of the funnel member.

[0085] In certain embodiments, the connector is a tubular extension that extends from a rim of the aperture in the wall of the funnel member.

[0086] In certain embodiments, the endoscopic bite block further includes an insert to be received in the passage, the insert being substantially tubular and elongate, and having a tailing end that protrudes from the second end of the body when inserted, and wherein, a side wall of the tailing end includes an aperture therein.

[0087] In certain embodiments, the insert includes a connector at the aperture.

[0088] In certain embodiments, the connector is a tubular extension that extends from a rim of the aperture in the side wall of the insert.

[0089] According to a further aspect, embodiments are disclosed of an endoscopic bite block assembly including: a bite block as described hereinabove; and a bag apparatus comprising an inflatable bag, an outlet connected with the connector of the bite block, and an inlet for connection with a gas supply.

[0090] According to a further aspect, embodiments are disclosed of a method of administering oxygen to a patient during an endoscopic procedure wherein the endoscope is inserted through the mouth including: fitting a bite block assembly, as described hereinabove, to a patient; and supplying oxygen to the patient via the inlet of the bag apparatus.

[0091] According to a further aspect, embodiments are disclosed of an endoscopic bite block kit, including: a bite block as described hereinabove; and a bag apparatus comprising an inflatable bag, an outlet for connection with the connector of the bite block, and an inlet for connection with a gas supply.

[0092] According to a further aspect, embodiments are disclosed of an endoscope guide for insertion though an endoscope passage in an endoscopic bite block, the guide comprising a tubular passage that extends between two end openings, the tubular passage having a wall with one or more apertures therein.

[0093] In certain embodiments, the guide is elongate and curved at least along a portion of its length.

[0094] In certain embodiments, at least a portion thereof is elastically deformable.

[0095] In certain embodiments, the endoscope guide includes a leading end to be inserted through the endoscope passage, and a tailing end, the tailing end including a stop extending therefrom configured to prohibit the tailing end from passing through the endoscope passage.

[0096] In certain embodiments, the leading end is more flexible than the tailing end.

[0097] According to a further aspect, embodiments are disclosed of an endoscope guide for insertion though an endoscope passage in an endoscopic bite block, the guide comprising first and second portions wherein the first portion provides a substantially tubular passage to guide the endoscope, and the second portion provides a stop that prohibits the second portion from passing through the endoscope passage.

[0098] In certain embodiments, the first portion is substantially straight along its length but has a leading end that opens to the side with respect to the longitudinal axis of the first portion.

[0099] In certain embodiments, the first and second portions of the guide are connected by snap fitting the first portion with the second portion.

[0100] In certain embodiments, the first and second portions of the guide are integrally formed with one another.

[0101] According to a further aspect, embodiments are disclosed of an endoscope guide for insertion though an endoscope passage in an endoscopic bite block, the insert being elongate and substantially tubular, the insert including a leading end to be inserted through the endoscope passage, and a tailing end that protrudes from the endoscope passage when inserted.

[0102] In certain embodiments, the insert has a funnel at the tailing end, to guide insertion of an endoscope.

[0103] In certain embodiments, the insert is substantially straight along its length and has a leading end that opens to the side with respect to the longitudinal axis of the insert.

[0104] In certain embodiments, a side wall of the tailing end includes an aperture therein.

[0105] In certain embodiments, the guide includes a connector at the aperture.

[0106] In certain embodiments, the connector is a tubular extension that extends from a rim of the aperture in the side wall of the insert.

[0107] According to a further aspect, embodiments are disclosed of an endoscopic bite block assembly including: a bite block as described hereinabove; and an endoscope guide as described hereinabove.

[0108] According to a further aspect, embodiments are disclosed of an endoscopic bite block kit including: a bite block as described hereinabove; and an endoscope guide as described hereinabove.

[0109] According to a further aspect, embodiments are disclosed of an endoscopic bite block assembly as described hereinabove, further including an endoscope guide as described hereinabove.

[0110] According to a further aspect, embodiments are disclosed of an endoscopic bite block kit as described hereinabove, further including an endoscope guide as described hereinabove.Brief description of the drawings

[0111] Embodiments of the present invention will be described in further detail with reference to the drawings in which:Figure 1 illustrates an isometric view of a prior art bite block;Figure 2 illustrates an isometric view of one embodiment of a bite block according to the present invention;Figure 3 illustrates a side view of the bite block shown in figure 2;Figure 4 illustrates a cross-sectional view of section C-C as marked in figure 3;Figure 5 illustrates a cross-sectional view of section D-D as marked in figure 4; andFigure 6 illustrates a sagittal plane view of the bite block shown in figures 2 to 5, when fitted in a patient’s mouth;Figure 7 illustrates a bite block assembly including a bite block as shown in figure 2, in connection with an example endoscope guide, bag apparatus, and funnel;Figure 8 illustrates a disassembled / exploded view of the bite block assembly of Figure 7;Figure 9 illustrates an embodiment of an endoscope guide for use with a bite block as shown in Figure 2;Figure 10 illustrates an embodiment of an endoscope guide that includes an additional / secondary tube portion for insertion of a gastric tube;Figure 11 illustrates an embodiment of a funnel for use with a bite block as shown in Figure 2;Figure 12 illustrates an isometric view of another embodiment of a bite block according to the present invention;Figure 13 illustrates an isometric view of a bite block assembly including a bite block as shown in figure 12, the bite block being in connection with an example endoscope guide;Figure 14 illustrates a top view of the bite block assembly shown in figure 13;Figure 15 illustrates a cross-sectional view of section E-E as marked in figure 14;Figure 16 illustrates a side view of the bite block assembly shown in figure 13;Figure 17 illustrates a cross-sectional view of section F-F as marked in figure 16;Figure 18 illustrates a top view of an embodiment of an endoscope guide for use with a bite block assembly as shown in figure 13;Figure 19 illustrates a cross-sectional view of section G-G as marked in Figure 18;Figure 20 illustrates an exploded view of the bite block assembly shown in figure 13;Figure 21 illustrates an isometric view of a bite block assembly including a bite block as shown in figure 12 in connection with an example endoscope guide;Figure 22 illustrates another isometric view of the bite block assembly shown in figure 21 ;Figure 23 illustrates a side view of another embodiment of an endoscope guide for use with a bite block assembly as shown in figures 21 and 22;Figure 24 illustrates a cross-sectional view of section H-H as marked in figure 23;Figure 25 illustrates a bite block assembly including a bite block as shown in figure 2, in connection with an example bag apparatus, and funnel;Figure 26 illustrates a side view of the bag apparatus shown in figure 25;Figure 27 illustrates a bite block assembly including a bite block as shown in figure 2, in connection with an example bag apparatus, and funnel;Figure 28 illustrates a side view of the bag apparatus shown in figure 27;Figure 29 illustrates a side view of another embodiment of a bag apparatus for use with a bite block assembly shown in figures 13 and 21 ;Figure 30 illustrates a bite block as shown in figure 12 with a cap at the connector;Figure 31 illustrates a schematic side view of the endoscope guide shown in figures 23 and 24, which includes a sealing element, wherein the inflatable balloon portion of the sealing element is in the deflated state;Figure 32 illustrates a schematic side view of the endoscope guide and the sealing element shown in figure 31 , wherein the inflatable balloon portion of the sealing element is in the inflated state;Figure 33 illustrates a closeup side view of an example endoscope guide end for use with a bite block assembly shown in figures 13 and 21 ;Figure 34 illustrates a closeup front view of the endoscope guide end as shown in figure 33;Figure 35 illustrates an isometric view of another embodiment of a bite block according to the present invention, the bite block including an example insert / endoscope guide;Figure 36 illustrates another isometric view of the bite block shown in figure 35;Figure 37 illustrates a side view of the bite block shown in figures 35 and 36;Figure 38 illustrates a front view of the bite block shown in figures 35 and 36;Figure 39 illustrates an isometric view of an endoscope guide / insert for a bite block as shown in figures 35 and 36;Figure 40 illustrates a side view of the endoscope guide / insert shown in figure 39;Figure 41 illustrates a cross-sectional view of section l-l as marked in figure 40;Figure 42 illustrates an isometric view of a bite block body for use with a bite block as shown in figures 35 and 36;Figure 43 illustrates another isometric view of the bite block body shown in figure 42;Figure 44 illustrates another isometric view of the bite block body shown in figures 42 and 43;Figure 45 illustrates a top view of the bite block body shown in figures 42 to 44;Figure 46 illustrates a front view of the bite block body shown in figures 42 to 44;Figure 47 illustrates a cross-sectional view of section J-J as marked in figure 46;Figure 48 illustrates an isometric view of the bite block assembly shown in figure 13, the bite block assembly connected to an example of a connector portion of a bag apparatus that may be used with the bite blocks as described herein;Figure 49 illustrates a side view of the bite block assembly and connector portion shown in figure 48;Figure 50 illustrates a close-up view of section K of the bite block assembly and connector portion shown in figure 49;Figure 51 illustrates a cross-sectional view of section L-L of the bite block assembly and connector portion shown in figure 49;Figure 52 illustrates a cross-sectional view of section M-M of the bite block assembly and connector portion shown in figure 49;Figure 53 illustrates an isometric view of another embodiment of a bite block according to the present invention, the bite block including an example insert / endoscope guide;Figure 54 illustrates a side view of the bite block shown in figure 53;Figure 55 illustrates a front view of the bite block shown in figure 53;Figure 56 illustrates a cross-sectional view of section N-N as marked in figure 54;Figure 57 illustrates an isometric view of an endoscope guide / insert for a bite block as shown in figure 53;Figure 58 illustrates a rear view of the endoscope guide / insert shown in figure 57;Figure 59 illustrates a front view of the endoscope guide / insert shown in figure 57;Figure 60 illustrates a cross-sectional view of section 0-0 as marked in figure 59;Figure 61 illustrates an isometric view of a bite block body for use with a bite block as shown in figure 53;Figure 62 illustrates a top view of the bite block body shown in figure 61 ;Figure 63 illustrates a front view of the bite block body shown in 61 ; andFigure 64 illustrates a cross-sectional view of section P-P as marked in figure 63.Detailed description

[0112] General embodiments of the invention provide an endoscopic bite block that includes a body with a bite barrier portion to be located between the upper and lower teeth of a patient when the bite block is in a fitted position. The body has a passage therethrough for insertion of an endoscope. The passage extends between an opening at a first end of the body and an opening at a second end of the body. In the fitted position of the bite block, the first end is located behind the teeth of the patient and the second end is located in front of the teeth of the patient. The bite block also includes a retaining means configurable between a fitting position or configuration, which facilitates fitting of the bite block into the fitted position, and a retaining position or configuration, which facilitates retainment of the bite block in the fitted position.

[0113] In a first general form, the retaining means is a retaining member that is coupled to the body such that it can rotate with respect to the body, between fitting and retaining positions / configurations.

[0114] The bite barrier portion typically includes substantially parallel top and bottom outer biting surfaces, but may also, in some forms have curved top and bottom outer biting surfaces (e.g. that curve toward one another). It will also be appreciated that a single outer biting surface may extend around the bite barrier portion to receive / block the upper and lower teeth.

[0115] The retaining member generally provides an anchor portion at the first end of the body, that, when in the retaining position, hooks behind the patient’s teeth. The anchor portion is typically in the form of an elongate element with two ends that each extend laterally with respect to the direction from the first end of the body to the second end of the body. The ends of the elongate element typically extending in generally opposite directions. Rotation of the retaining member thereby providing the fitting position / configuration (which facilitates insertion / removal) when the direction of elongation of the anchor portion is, with reference to fitted position of the bite block, substantially parallel to the transverse plane of the patient, so as to allow for easy insertion / removal through the space between the top and bottom teeth of the patient.Conversely, when the retaining member is rotated into the retaining position (which inhibits removal of the bite block), the direction of elongation of the anchor portion is, with reference to the fitted position of the bite block, substantially perpendicular to the transverse plane of the patient so the anchor portion hooks behind the patient’s teeth.

[0116] The ends of the anchor portion / elongate element may be curved in a direction away from the body of the bite block. This provides that, in the retaining position, the ends conform to the general shape of hard palate and lower gum area, reducing the likelihood of injury to patient. Furthermore, the ends are typically in the form of or include tab portions, to provide sufficient contact faces that can lie against the hard palate / lower gum area of the patient without cutting into or injuring the patient. The ends may also have a degree of flexibility to assist with conformation to the hard palate / lower gum area again in seeking to avoid / minimise injury to the patient (e.g. damage to the mucosa etc).

[0117] Generally, the passage through the bite block body is substantially cylindrical, and the retaining member includes a substantially tubular portion that is fitted concentrically within the passage such that it can rotate therewithin. For example, an inner wall surface of the passage and an outer wall surface of the tubular portion may have cooperating formations thereon that prohibit over-rotation of the retaining member beyond the fitting and retaining positions.

[0118] Generally, the body further includes a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position. This assists with location of the bite block during fitting, and acts to help clamp the teeth in combination with the anchor portion, when the retaining member is moved into the retaining position.

[0119] Typically, the wall portion extends laterally from the bite barrier portion at the second end (i.e. end region) of the body, with respect to a direction from the first end to the second end of the body. The wall portion is usually substantially U-shaped providing opposing arms, with the arms extending initially laterally from the bite barrier portion at the second end of the body, and then in the direction of the first end of the body. In the fitting position of the retaining member, the elongate element typically has a direction of elongation that is in the plane of the opposing arms of the wall portion, and in the retaining position of the retaining member, the elongate element typically has a direction ofelongation that is angled, typically perpendicular, with respect to the plane of the opposing arms of the wall portion.

[0120] Generally, one of the arms includes an aperture therein, and a connector is typically included at the aperture. The connector may, for example, be a tubular extension that extends from a rim of the aperture. The connector may be, for example, configured for connection with an gas (e.g. oxygen) supply device or apparatus, such that gas / oxygen can be supplied more directly into the oral cavity, through the aperture. It will be appreciated that a connector may not strictly be required, with connection of a gas supply device or apparatus being directly to the aperture.

[0121] The wall portion is typically shaped / configured to provide a seal with respect to the mouth opening of the patient. The wall portion main faces typically being solid (as in continuous so there is no perforation through the wall portion) apart from the aperture. The seal helps to prevent oxygen / gas supplied through the connector leaking out from the oral cavity. In addition, to further avoid leakage, the passage may include one or more partitions therein and / or end closures which may provide a seal around the endoscope when inserted therethrough. A partition / end closure may for example have an expandable opening for receiving the endoscope therethrough, so as to thereby provide the seal around the endoscope when inserted. For example, a partition / end closure may comprise a flexible diaphragm with a stretchable hole therein, or may comprise a flexible wall with one or more slits therein, that may intersect. Alternatively, a partition or end closure may be configured to be openable to permit insertion of the endoscope (or other instrument / apparatus), and also configured to automatically seal / close once the endoscope / instrument is removed (e.g. by being biased to seal / close), for example being a form of one-way valve for the endoscope. Such automatically closing / one-way valve type forms may also provide a seal around the endoscope when inserted.

[0122] It will be appreciated that both seals might be imperfect (i.e. might not be completely fluid tight) and may therefore only provide a substantial or partial sealing effect.

[0123] The rotating retaining member may include a handle portion that extends from the tubular portion at the second end of the body and outside the passage, such that a practitioner can rotate the retaining member via the handle portion. Alternatively, the bite block may include a funnel at the second end of the body to guide insertion of anendoscope into the passage opening at the second end of the body. The funnel may be connected to the retaining member such that rotation of the funnel rotates the retaining member. In this way the funnel may also be used as a handle. In some examples, the funnel may be part of a funnel member that includes a tubular portion that is concentrically fitted within the tubular portion of the retaining member.

[0124] In a second general form, the retaining means comprises at least one arm movable between a retracted position and a deployed position, wherein the retracted position provides the fitting position or configuration, and the deployed position provides the retaining position or configuration. Typically, in the retracted position, the at least one arm extends into the passage, so as to provide minimal interference during insertion into the patient’s mouth, between their top and bottom teeth. Typically, the at least one arm is biased to, or rests in, the retracted position. For example, the at least one arm may be formed to be in the retracted position, and then flexed to the deployed position (e.g. the at least one arm may be formed of a flexible yet resilient polymer material). In one example, the at least one arm is provided by a tongue formed in a wall of the passage of the bite block body.

[0125] Typically, in the deployed position, at least a portion of the at least one arm extends outward from body. As described previously, the bite barrier portion typically provides upper and lower outer biting surfaces. The at least one arm is typically formed in the upper and / or lower outer biting surfaces. The at least one arm is typically bent at a free end thereof, to provide a region of the at least one arm that protrudes with respect to the upper and lower outer biting surfaces when the at least one arm is in the deployed position, with the remainder of the at least one arm sitting substantially flush with the upper and / or lower outer biting surfaces.

[0126] Usually, there are two arms, with one arm formed in the top outer biting surface, and the other arm formed in bottom outer biting surface.

[0127] In the second general form, the bite block typically includes an insert to be received in the passage such that when inserted, the at least one arm is moved into and maintained in the deployed position. The insert may be an endoscope guide and is typically elongate and tubular (typically with a substantially circular cross section).

[0128] Generally, the insert includes a tailing end that protrudes from a second end of the body when inserted therein. Typically, the insert has a funnel at the tailing end, toguide insertion of an endoscope. In the second general form, the insert typically includes an aperture in a side wall thereof, to allow for gas supply (as opposed to the wall portion like in the first form). As such the insert typically includes a connector at the aperture to allow for connection with gas supply / device. Typically, the connector is a tubular extension that extends from a rim of the aperture. However, again it will be appreciated that a gas supply / device may alternatively be connected directly to the aperture without a connector.

[0129] Generally, the insert includes a leading end that protrudes from the first end of the body when inserted therein. The insert is typically substantially straight along its length. Typically, the leading end opens to the side with respect to the longitudinal axis of the insert. It will be appreciated that in some forms, the insert may not be fully straight, and may have some degree of curvature. It will be appreciated that in some forms, the opening at the leading end opens to the side with respect to the centreline axis of the insert (which is typically substantially tubular with a circular cross section). The insert may include a partition therein and / or end closure as previously described, which may form a seal around the endoscope when inserted and / or close off the insert when the endoscope is removed.

[0130] As with the previously described first form, the passage of the bite block body is typically substantially cylindrical. The insert when inserted is typically fitted concentrically within the passage such that it can rotate therewithin. The body and the insert may each have cooperating formations thereon that limit rotation of the insert when inserted in the body.

[0131] Also as with the previously described first form, in the second form the body further includes a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position. The wall portion typically being shaped to provide a sealing effect with respect to the mouth opening of the patient. With respect to the direction from the first end of the body to the second end of the body, the wall portion typically extends laterally from the bite barrier portion at the second end (i.e. end region) of the body. The wall portion is typically substantially U or C-shaped, providing opposing arms, the opposing arms extending initially laterally from the bite barrier portion at the second end of the body and then in the direction of the first end of the body.

[0132] It will be appreciated that the retaining means can be other forms than as described in the above two forms, such as, for example the retaining means may be a telescopic element that extends / retracts, or a balloon that inflates / deflates.

[0133] Further general embodiments of the invention provide an endoscopic bite block including a body with a bite barrier portion to be located between the upper and lower teeth of a patient when the bite block is in a fitted position, the body having a passage therethrough for insertion of an endoscope, wherein the passage extends between an opening at a first end of the body and an opening at a second end of the body, and in the fitted position of the bite block, the first end is located behind the teeth of the patient and the second end is located in front of the teeth of the patient, the body further including a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position.

[0134] The wall portion typically includes an aperture therein and a connector may extend therefrom for connection with a gas supply. The connector may for example be a tubular extension that extends from a rim of the aperture. The wall portion typically extends laterally from the bite barrier portion at the second end of the body, with respect to a direction from the first end to the second end of the body. For example, the wall portion may be substantially U-shaped providing opposing arms, with the arms extending initially laterally from the bite barrier portion at the second end of the body, and then in the direction of the first end of the body. In such examples the aperture may be located in one of the arms.

[0135] The wall portion is typically shaped / configured to provide a seal with respect to the mouth opening of the patient. The wall portion main faces typically being solid (as in continuous so there is no perforation through the wall portion) apart from the aperture. The seal helps to prevent oxygen supplied through the ape rture / conn ecto r leaking out from the oral cavity. In addition, to further avoid leakage, the passage may include one or more a partitions therein and / or end closures as previously described.

[0136] Some embodiments of the invention may have an aperture in a funnel member rather than in the wall portion. In such embodiments the funnel member typically includes a connector at the aperture, configured for connection with a gas supply / apparatus. Also typically, in such embodiments, the funnel member includes aneck region that protrudes from the second end of the body when inserted, and the aperture is disposed at the neck region of the funnel member.

[0137] Similarly, in some embodiments, the bite block may include an insert to be received in the passage, the insert being substantially tubular and elongate, and having a tailing end that protrudes from the second end of the body when inserted. In such embodiments, a side wall of the tailing end may includes the aperture therein for receiving gas, and where a gas supply connector may be located. Again the connector may be a tubular extension that extends from a rim of the aperture in the side wall of the tailing end of the insert.

[0138] Embodiments of the bite block which include the aperture for receiving gas supply, typically via connector, allow for an endoscopic bite block assembly (or kit for assembling same) which comprises a bite block in combination with a bag apparatus. The bag apparatus typically comprises an inflatable bag, an outlet for connection with the aperture / connector of the bite block, and an inlet for connection with a gas supply. In use the bag apparatus may be connected to the aperture / connector of the bite block and continuously supplied with oxygen from an oxygen supply via the inlet such that the bag is continuously inflated. When the bag is fully inflated, excess oxygen spills into the oral cavity through the aperture in the wall portion (e.g. via the connector). When the patient inhales, each breath has an increased oxygen concentration, from a combination of the oxygen already spilled into the oral cavity, and that which is inhaled / drawn out from the bag. As the bag is continually inflated, the bag is fully inflated before the patient exhales, and any exhaled (reduced oxygen) air is expelled via the nose, rather than back into the bag. This prevents rebreathing of exhaled air. As previously mentioned a connector may not strictly be required with direct connection of the bag apparatus to the relevant aperture in the bite block being possible.

[0139] Embodiments of invention therefore also relate to a method of administering oxygen to a patient during an endoscopic procedure wherein the endoscope is inserted through the mouth. Such methods including fitting such a bite block assembly to the patient and supplying oxygen to the patient via the inlet of the bag apparatus.

[0140] Furthermore, bite blocks as described herein, and other bite blocks, may optionally be used with an endoscope guide which both acts to prevent the tongue fromblocking the patient airway, and guides the endoscope behind the tongue, into the oropharynx.

[0141] The present disclosure also relates to endoscope guides for insertion though an endoscope passage in a bite block.

[0142] In some embodiments the endoscope guide comprises a tubular passage extending between two end openings, the tubular passage having a wall with one or more apertures therein. Such apertures provide that air / gas may flow therethrough, into and out of the passage. Generally, the guide is elongate and curved for at least a portion along its length.

[0143] At least a portion of the guide is also typically elastically deformable, so as to assist with insertion into the bite block passage, which may have a slightly smaller cross- sectional area. The endoscope guide generally includes a leading end to be inserted through the bite block passage, and a tailing end, with the tailing end including a stop extending therefrom that is configured to prohibit the tailing end from passing through the passage. In some forms, the leading end may be more flexible than the tailing end. The leading end, for example, may elastically deform to pass through the bite block passage, before returning to its undeformed state, whereas the tailing end may be more rigid, and be shaped to fit to or have a tight fit within the bite block passage.

[0144] In further embodiments, the endoscope guide comprises first and second portions wherein the first portion provides a substantially tubular passage to guide the endoscope, and the second portion provides a stop that prohibits the second portion from passing through the endoscope passage of the bite block. Typically, the first portion is substantially straight along its length but has a leading end that opens to the side with respect to the longitudinal axis of the first portion. In some embodiments the first and second portions of the guide are connected by snap fitting, whilst in others they may be integrally formed. In yet further embodiments, the endoscope guide may be elongate and substantially tubular (typically with a cylindrical cross section), including a leading end to be inserted through the endoscope passage, and a tailing end that protrudes from the endoscope passage when inserted.

[0145] The guide may have a funnel at the tailing end, to guide insertion of an endoscope. The guide may be is substantially straight along its length and has a leading end that opens to the side with respect to the longitudinal axis of the insert.

[0146] A side wall of the tailing end may include an aperture therein, and a connector for a gas supply apparatus may be included therein. The connector may be a tubular extension that extends from a rim of the aperture in the side wall of the insert.

[0147] Embodiments of the invention therefore also relate to bite block assemblies (or kits for assembling same) which include endoscope guides as described herein.

[0148] One example form of an endoscopic bite block according to the invention is shown in Figures 2 to 8. The bite block (1 ) includes a body (2) with a cylindrical passage (3) therethrough for receipt of an endoscope (not shown). The passage (3) extends between an opening (4) at a first end (5) of the body (2) and an opening (6) at a second end (7) of the body (2). When the bite block (1 ) is fitted to a patient, the first end (5) is located behind the teeth (104, 121 ) of the patient and the second end (7) is located in front of the teeth (104, 121 ) of the patient. See, for example, Figure 6 which shows fitted placement within the mouth of a patient. It will be appreciated that the passage (3) might not always be cylindrical, and may have a non-circular cross section.

[0149] The body (2) includes a bite barrier portion (8) and wall portion (9). It will be appreciated that the bite barrier portion and wall portion may be integrally formed to provide the body (2), or may be individually manufactured and secured together to form the body (2). The bite barrier portion (8) is substantially the shape of a square prism and includes substantially parallel top and bottom outer biting surfaces (10, 11 ), and substantially parallel outer side surfaces (12, 13) that join the top and bottom outer biting surfaces (10, 1 1 ). The edges between the outer top, bottom and side surfaces (10, 11 , 12, 13) are rounded. In some forms, the top and bottom surfaces (10,1 1 ) of the bite barrier portion have a degree of softness or have a soft covering so as not to damage the patient’s teeth.

[0150] With respect to the direction (Y) from the first end of the body to the second end of the body, the wall portion (9) extends laterally from the bite barrier portion (8) at the second end (7) of the body (2). The wall portion (9) is substantially U-shaped so as to fit along the outer surface of the teeth (104, 121 ) of the patient, but behind the lips of the patient. The ends of the U-shaped wall portion thus provide opposing arms (14, 15), with each arm extending initially laterally from the bite barrier portion at the second end (7) of the body (2) and then in the direction of the first end (5) of the body (2). It will be appreciated that the arms (14, 15) thus extend in the same general plane (P), as shownin figure 2. Whilst the embodiments as shown in the figures provide a wall portion that is substantially U-shaped, other forms may have the wall portion being substantially flat or planar. Also, in some forms, the wall portion may have a degree of curvature from top to bottom (i.e. in the direction perpendicular to the shared general plane of arms (14, 15)). Furthermore, the arms (14, 15) may also be somewhat flexible (although resilient), to assist with fitting / positioning of the bite block (1 ).

[0151] A retaining member (16) is rotatably coupled to the body (2) and provides an anchor portion (17) at the first end (5) of the body (2). The anchor portion (17) is connected to a tubular portion (18) that is concentrically fitted within the passage (3) of the body (2) such that it can rotate therein, and thereby provides for the rotating movement of the retaining member (16).

[0152] As shown in Figure 5, an inner wall (19) of the passage (3) and an outer wall (20) of the tubular portion (18) have cooperating formations thereon that prohibit overrotation of the retaining member (16) beyond the fitting and retaining positions. In particular, the inner wall surface (19) of the passage (3) includes two recesses (21 ) that receive corresponding protrusions (22) on the outer wall surface (20) of the tubular portion (18) of the retaining member (16). Abutting of the protrusions (22) against respective side walls (21 a) of the recesses (21 ) prohibits over rotation of the retaining member (16) beyond the fitting and retaining positions. In this example rotation of the retaining member (16) is limited to about 90°.

[0153] The anchor portion (17) of the retaining member (16) is in the form of an elongate element with two ends (23, 24) that each extend laterally (with respect to the direction (Y) from the first end of the body to the second end of the body) from the tubular portion (18) at the first end (5) of the body (2), in generally opposite directions. The elongate element is essentially flange or wing like to provide tab portions at the two ends (23, 24). In the fitting position of the retaining member (16), the anchor portion / elongate element (17) has a general direction of elongation that is in the plane of the opposing arms (14, 15) of the wall portion (9) (see e.g. figure 2). In the retaining position (see e.g. Figure 6), the anchor portion / elongate element (17) has a general direction of elongation that is angled, and typically perpendicular, to the plane of the opposing arms (14, 15). When the bite block (1 ) is fitted, the arms (14, 15) of the wall portion (9) extend along the outer surface of the teeth (104, 121 ) of the patient, so it will be appreciated that when retaining member (16) is rotated into the retaining position, the anchor portion (17) has adirection of elongation that is perpendicular to the transverse plane of the patient, and so operates to lock the bite block (1 ) in position by hooking behind the teeth (104, 121 ) of the patient.

[0154] The ends of the anchor portion / elongate element (23, 24) are curved in a direction away from the bite block body (2) so as to provide a degree of conformation with the hard palate (1 1 1 ) and lower gum area (122) of the patient, when moved into the retaining position. Furthermore, it will be appreciated that the fitted position of the bite block (1 ) is typically snug, being such that when retaining member (16) is moved into the retaining position, the bite block (1 ) essentially clamps the teeth (104, 121 ), with the tab portions (23, 24) contacting the hard palate (11 1 ) and lower gum area (122), to pull the wall portion (9) against the front of the teeth (104, 121 ) of the patient.

[0155] It will be appreciated that in other forms, the end / tab portions (23, 24) may not be strictly curved, but may be otherwise bent or angled away from the body with a view to promoting conformation to the hard palate (111 ) / lower gum area (122).

[0156] In typical use, the bite block is first set to the fitting position by moving the retaining member (16) such that the anchor portion / elongate element (17) has a direction of elongation that is in a plane of the arms (14, 15) of the wall portion (9) (e.g. as shown in figure 2). The bite block (1 ) is then placed between the patient’s teeth (104, 121 ), such that upper and lower teeth (104, 121 ) are respectively at the top and bottom biting surfaces (10, 11 ) of the bite barrier portion (8), and such that the wall portion (9) is located in front of the teeth (104, 121 ), but behind the lips of the patient. The retaining member (16) is then rotated into the retaining position such that the anchor portion / elongate element (17) hooks behind the patient’s teeth (104, 121 ) to secure the bite block in position.

[0157] The rotation may be actuated by several means. In the figures as shown, an optional funnel member (25) is secured to the tubular portion of the retaining member (16) such that rotation of the funnel (25) also rotates the retaining member (16). Securement is by a tubular portion (26) of the funnel (25) concentrically fitted within the tubular portion (18) of the retaining member (16). As shown in Figure 5, an outer wall surface (27) of the tubular portion (26) of the funnel (25) has protrusions (28) that are shaped to fit within corresponding recesses in an inner wall surface (29) of the tubular portion (18) of the retaining member (16). The funnel (25) widens from the tubular portion (26) thereof, atthe second end of the body. In other embodiments, where a funnel might not be included, the retaining member (16) might simply be turned by inserting a finger into the tubular portion (18) thereof, or with the inclusion of some other handle extension / portion that extends from the tubular portion (18) to outside the passage (3), at the second end (7) of the body (2). Whilst the funnel member (25) is optional, it does provide additional advantages in that it helps to guide insertion of the endoscope into the passage opening (6) at the second end (7) of the body (2). As shown in figure 11 , the funnel may include a flange (43) that prohibits over-insertion thereof (i.e. by abutting a rim of the passage).

[0158] In addition to the above securement advantages, the bite block (1 ) also includes an aperture (30) in one of the arms (15) of the wall portion (9), which allows for improved oxygen intake by the patient. A connector extends from the wall portion (9) at the aperture (30) to allow for connection with a gas supply device / apparatus, and in particular oxygen supply devices / apparatus. In the embodiment shown the connector is in the form of a tubular extension (31 ) which extends from a rim of the aperture (30). Optionally, an openable port may be included in the wall portion (for example in the region (Z)) for connection of a CO2 sensor, the port typically having a closure or cap that is openable for connection of the sensor. The CO2 sensor may be used to monitor the CO2 levels in the oral cavity.

[0159] To facilitate oxygen intake and reduce dilution within the oral cavity, the wall portion (9) is shaped / configured to provide a seal with respect of the mouth opening of the patient. In particular, to provide the seal, the wall portion main faces (9a, 9b) are solid (as in continuous so there is no perforation through the wall portion) apart from the aperture (30). In embodiments, where the CO2 sensor port is included, it will be appreciated that the port is normally covered by a cap / closure unless the CO2 sensor is attached, such that the main faces are continuous / solid, and the described sealing effect is provided. As would be appreciated the seal helps to prevent oxygen supplied through the connector leaking out from the oral cavity. In some forms (not shown), either or both of the main faces (9a, 9b) might include a protruding ridge or frame of cushioning or soft deformable material that extends around the periphery portion of the faces, to thereby increase the sealing effect of the wall portion (e.g. when implemented on the inner / teeth facing main face (9b), the cushioning material would press up and conform to teeth / gums of the patient when the bite block is secured). Alternatively (also not shown), to similarly provide an increased sealing effect, an inflatable cuff or frame may extend around aperiphery portion of one or both main faces (9a, 9b). The inflatable cuff or frame would typically be inflated once the bite block (1 ) is in the fitted position (for example by pilot tube or via the aperture (30)), expanding to fill the space between the wall portion and the teeth and / or the lips / cheeks of the patient. Such forms, which provide an increased sealing effect, are advantageous in circumstances where intermittent positive pressure ventilation may be applied through the connector (which is described later).

[0160] In addition, to further avoid leakage, the passage may include a partition therein and / or an end closure (not shown) which may provide a seal around the endoscope when it is inserted therethrough. A partition / end closure may for example have an expandable opening for receiving the endoscope therethrough, so as to provide a seal around the endoscope when it is inserted. For example, a partition / end closure may comprise a diaphragm with a stretchable hole or may comprise a flexible wall with one or more slits therein, that may intersect. For example, the flexible wall may have two slits that intersect, to form an “X” shaped opening, which therefore provides four flexible tabs which bend to allow insertion of the endoscope. It will be appreciated that a partition or end closure may be configured to be openable to permit insertion of the endoscope or other instrument / apparatus, and also configured to automatically seal / close once the endoscope / instrument is removed (e.g. by being biased to seal / close), for example being a form of one-way valve for the endoscope. Such forms (i.e. auto-closing forms) may also provide a seal around the endoscope when inserted. It will be appreciated the inclusion of a partition / end closure further contributes to leak prevention by stopping leakage through the passage around the endoscope, and in the case of the automatically closing I one way valve type forms, fully closes / seals off that passage once the endoscope is removed. In some embodiments, multiple partitions / end closures may be included to enhance the sealing effect, each of which may each be of the same or different forms (e.g. one with slits, one comprising a one way valve type etc.).

[0161] It will be appreciated that both seals (i.e. provided by the wall portion (9) or the partition / end closure) might be imperfect (i.e. might not be completely fluid tight) and may therefore only provide a substantial or partial sealing effect. In some cases, to provide yet further sealing, tape may be additionally applied over the lips of the patient after the bite block has been fitted.

[0162] In one example (as shown in Figure 7), a bag apparatus (200) may be fitted to the tubular extension (31 ). The bag apparatus (200) typically has an inflatable bagportion (201 ), and a connector portion (204) comprising an inlet (202) for inflation, and an outlet (203) to be connected to the tubular extension (the inlet and outlet may be two connection points of a T-connector (204), with the third connection point connecting to the inflatable bag portion (201 )). In typical use, the bag apparatus (200) is continuously supplied with oxygen from an oxygen supply via the inlet such that the bag is continuously inflated. When the bag is fully inflated, excess oxygen spills into the oral cavity via the aperture (30). When the patient inhales, each breath has an increased oxygen concentration, from a combination of the oxygen already spilled into the oral cavity, and that which is inhaled / drawn out from the bag. As the bag is continually inflated, the bag is fully inflated before the patient exhales, and any exhaled (reduced oxygen) air is expelled via the nose, rather than back into the bag. It will therefore be appreciated that the bite block allows for an assembly, when combined with an appropriate bag apparatus, that allows for a novel and improved method for administering oxygen to a patient during an endoscopic procedure (wherein the endoscope is inserted through the mouth) such that the risk of hypoxia is reduced. It will be appreciated that in other forms, an oxygen supply may be connected directly to the connector (31 ), without the bag apparatus. It will also be appreciated that movement / collapsing of the bag caused inhalation of the patient also provides a visual indicator of the patient’s breathing to an attending medical professional.

[0163] In some forms, as shown in figures 25 to 28, the bag apparatus (200) may have a connector portion (204A, 204B) which further includes an additional outlet / opening (208). The additional outlet / opening (208) provides an additional passage for exhaled air through to the external environment (i.e. other than through the nose). The outlet / opening (208) therefore assists to avoid buildup of CO2 in the patient and bag apparatus (200. Also, the additional outlet / opening (208) allows, for example, excess O2 (or other gas) from the bag apparatus to be released to the external environment, i.e. when the bag is fully inflated. That is, instead of all spilling into the oral cavity, excess O2 (or other gas) from the bag can additionally exit through opening (208). In some forms, the outlet / opening (208) may be part of a tubular extension (205A), as shown in figures 25 and 26, or may simply be a hole (205B) in a wall of the connector portion (204B), as shown in figures 27 and 28. Typically, the additional outlet / opening (208) is positioned on the connector portion (204A, 204B) further away from the bag portion (201 ) than the inlet (202), so that received gas from an external supply may be first directed into the bagrather than out through the opening (208) (e.g. via an appropriate internal construction of the connector portion).

[0164] In other forms, as shown in figure 29, the connector portion (204C) may include a cap or end portion (206C) at the inflation inlet (202), which has an inlet opening (220C) and one or more additional openings (207C) spaced from the inlet opening (220C). The openings (207C) allow for exhaled air to pass therethrough to the external environment. The cap / end portion (206C) narrows to a tip where the inlet opening (220C) is provided. The additional openings (207C) are spaced from the tip at the wider portion of the cap / end portion (206C). This configuration reduces the amount of oxygen / gas (i.e. , that which is received through the inlet opening (220C)) from escaping through the openings (207C), but at the same time encourages exhaled (reduced oxygen) air out through the openings (207C). It will be appreciated the cap / end portion (206D) may be alternatively located at the end of the connector (31 ) of the bite block (1 A), as shown for example in figure 30.

[0165] Another form of connector portion (204D) is shown in figures 48 to 52. Here the connector portion (204D) includes an internal structure in the form an internal wall (209) that directs gas received through the inlet (202D) (e.g. from a gas supply) in the direction toward / into the bite block / oral cavity.

[0166] Also optionally, as shown in figures 7 to 10, an endoscope guide (300) may be used with the bite block (1 ), in order to both guide the patient’s tongue away from blocking the patient airway, and to guide the endoscope into the oropharynx. The guide (300) comprises a tubular portion (301 ) forming a passage that extends between two end openings (31 1 , 312). The tubular portion (301 ) having a wall with a plurality of apertures (304) therein.

[0167] In typical use, a leading end (305) of the endoscope guide (300) is inserted through the passage opening (6) at the second end (7) of the body (2), and is pushed out through the passage opening (4) at the first end (5) of the body (2). A stop in the form of a flange (307) at the tailing end (306) of the guide (300) operates to prohibit the tailing end (306) passing through the passage (3), typically by abutment with a rim of the passage opening (6) at the second end (7) of the body (2) or the sloping wall of the funnel (25). In some forms, the guide (300) may include a handle (not shown) that extends from the tailing end, to assist with insertion / removal of the guide.

[0168] The endoscope guide (300) is elongate and curved along its length, with the degree of curvature increasing toward the leading end (305), so as so provide a guide path for the endoscope toward the oropharynx, when fitted.

[0169] To assist with insertion, the endoscope guide (300) is typically elastically deformable such that it can be squeezed into the passage (3), and thereafter, after it exits the passage opening (4) at the first end (5) of the body (2), it returns to its original or undeformed shape. In one example, to facilitate this, the leading end (305) may be more flexible than the tailing end (306). The leading end (305), for example, may elastically deform to pass through the bite block passage (3), before returning to its undeformed state, whereas the tailing end (306) may be more rigid, and may be shaped to fit to or have a tight fit within the bite block passage (3). Alternatively or additionally, side wall portions (303) of the tubular portion (301 ) may be more flexible than the upper / lower wall portions (302) thereof, and may move inwards to reduce the cross-sectional area of the guide (300). In one example (not shown), the endoscope guide may have a rigid spine that extends along its length in the upper and lower wall portions, with transverse less rigid ribs extending therefrom into the side wall portions.

[0170] It will also be appreciated that the endoscope guide (300) also operates as an airway tube, maintaining the patient airway such that oxygen received through the connector has a clear pathway to the lungs. As the leading end (305) of the endoscope guide (300) typically substantially fills the patient airway in the throat area, the apertures (304) in the wall of the tubular portion (301 ) allow for gas flow into and through the tubular portion (301 ). For example, gas / oxygen received from the connector / aperture in the area behind the teeth of the patient can then flow through the guide (300) into the lungs, typically in space around the endoscope. It will be appreciated that the endoscope guide (300) is shaped to have a larger diameter / cross sectional area than the endoscope to allow for sufficient gas / oxygen flow around the endoscope. Similarly, when the patient exhales, the apertures (304) allow for escape of exhaled gas into the oral cavity and out through the nose, noting that the passage for exhalation out the mouth is substantially blocked (by sealing effect of the wall portion (9) and seal around the endoscope).

[0171] In some forms, see e.g. Figure 10, the endoscope guide (300) may have an additional secondary tubular portion (308), that extends alongside the main tubular portion (301 ) to allow for insertion of a gastric tube. In practice, vision through an endoscope (e.g. bronchoscope) inserted through the main tubular portion (301 ) may beused to assist with insertion / placement of a gastric tube inserted through the secondary tubular portion (308). The provision of an additional passage / tubular portion for a gastric tube is typically of use during bronchoscopies, whereas gastroscopes may have a gastric tube already incorporated as part of the scope. It will be appreciated that both main and secondary tubular portions (301 , 308), whilst illustrated to have substantially circular cross sections, may also have non-circular cross sections. In another form, there may only comprise a single main tubular portion (e.g. 301 ) that has two end closures (e.g. 41 , 42), such that the endoscope (e.g. bronchoscope) and gastric tube travel through the same passage, but exit from separate end closures.

[0172] It will also be appreciated that where an endoscope guide (300) or funnel (25) is used, one or more partitions / end closures that provide a seal around the endoscope, like that which may be included in the passage (3), may alternatively or additionally also be provided in / at the end of the tubular portion (301 ) of the endoscope guide (300), and / or in / at an end of the funnel. Figure 10 shows one example of an end closure (41 ) for the endoscope guide which provides a sealing effect around the endoscope when inserted. It comprises two slits that intersect to form an “X” shaped opening, which thus provides four flexible tabs that bend to allow insertion of the endoscope. A similar end closure (42) may also be provided at the end of the secondary additional tubular portion (308). As previously discussed, the end closures (41 / 42) as shown, or other partitions / end closures might alternatively comprise a form of one way valve for the endoscope, opening to allow insertion of the endoscope (or other instrument / apparatus), and more fully sealing / closing automatically once the endoscope / instrument is removed. Figure 1 1 indicates a typical position (44) for an end closure / partition, which may be, as described previously, be a slitted wall / diaphragm or a form of one-way valve.

[0173] It will further be appreciated that to facilitate sealing around the guide (300) when inserted into the passage (3), the guide (300) is usually sized / shaped so that it must be squeezed to fit through the passage (3) (typically with the aid of a lubricant), such that the restoring force thereof provides a sealing effect, as the guide (300) seeks to restore to its original shape within the passage (3). Alternatively, the tailing end (306) may be sized to correspond to the size of the bite block passage (3).

[0174] A further example form of an endoscopic bite block according to the invention is shown in Figures 12 to 20. The bite block (1 A) is similar to the bite block (1 ) shown in Figures 2 to 8, but differs in that the connector (31 ) for gas supply extends from the funnelmember (25A) rather than from the wall portion (9). Whilst the funnel member (25A) similarly includes a tubular portion (26) for insertion into the tubular portion (18) of the retaining member (16), it further includes a neck region (26a) that protrudes from the passage (3) / retaining member (16). The neck region (26a) includes an aperture (30) therein, from which connector (31 ) extends. It will be appreciated that similar to as described for the embodiment of Figure 4, the tubular portion (26) of the funnel member (25A) has protrusions (28) that are shaped to fit within the corresponding recesses in an inner wall surface (29) of the tubular portion (18) of the retaining member (16), such that rotation of the funnel member (25A) rotates the retaining member (16) (e.g. between the fitting and retaining positions).

[0175] As previously discussed, the connector (31 ) allows for gas supply through the aperture (30) by connection with other devices / apparatus, and in particular oxygen supply devices / apparatus. For example, a bag apparatus (200) may be fitted to the connector of the bite block (1 A), similar to the way shown in Figure 7.

[0176] It will also be appreciated that in such forms, the previously described optional openable port, for connection of a CO2 sensor, may also be located in the neck region (26A) of the funnel member (25A), rather than the wall portion (9) as previously described in respect of bite block (1 ) of figures 1 to 8.

[0177] It will be appreciated that other aspects of the bite block (1 A) are similar to the bite block (1 ) shown in figures 2 to 8.

[0178] Also shown in figures 13 to 24, are further examples of endoscope guides (300A, 300B) that are particularly configured for use with the bite block (1A). The endoscope guides (300A, 300B) comprise first and second portions (350, 450). The first portion (350) provides a tubular portion (301 ) for passage of the endoscope, and the second portion (450) is configured for location within the neck region (26A) of the funnel member (25A). The second portion (450) also acts as a stop to prevent the guide (300A / 300B) from travelling through bite block (1A) when inserted.

[0179] Figures 18 and 19 show one example of endoscope guide (300A) where the first and second portions (350, 450) are releasably secured to one another by snap fitting engagement between the tailing end (306) of the first portion (350) and the leading end (405) of the second portion (450). When secured, the first and second portions (350, 450) are coupled such that rotation of the second portion (450) causes rotation of the firstportion (350). Alternatively, as shown in the form of endoscope guide (300B) of Figures 23 and 24, the first and second portions (350, 450) may be integrally formed.

[0180] In typical use, when the bite block (1 A) is fitted to the patient, the leading end (305) of the first portion (350) is inserted into the funnel member (25A), and through the passage opening (6) at the second end (7) of the body (2). The leading end of the first portion is then pushed out through the passage opening (4) at the first end (5) of the body (2). When fully inserted, the second portion (450) is disposed substantially within the neck region (26A) of the funnel member (25A), and is shaped to fit therewithin so as to prohibit the second portion (450) from passing through the passage (3). As shown in figures 13 to 24, the second portion (450) includes a handle (401 ) which extends from the tailing end (406) of the second portion. The handle (401 ) may be adapted to assist with the insertion and / or removal of the endoscope guides (300A, 300B).

[0181] As shown, the first portion (350) of these endoscope guides (300A, 300B) is elongate and substantially straight along its length but opens at a side of the leading end (305) such that the passage therethrough / endoscope path is curved at the leading end (305). Any endoscope inserted therein is therefore directed out to the side with respect to the longitudinal axis of the first portion (i.e. in typical use when the endoscope guide (300A / 300B) is oriented for use within the bite block (1 / 1 A) fitted to a patient, any endoscope inserted therein would be directed down the patients throat). It will be appreciated the guide path / passage of the endoscope may be adjusted by rotating the second portion (350), e.g. by rotating the handle (401 ) which then ultimately rotates the opening (31 1 ) at the side of the leading end (305) of the first portion (350). As shown, the figures, the leading end is curved and also ‘cut away’ to provide the opening such that it has a substantially bevelled overall shape.

[0182] It will also be appreciated that the endoscope guide (300A / 300B) also operates as an airway tube, maintaining the patient’s airway. The second portion (450) includes one or more side wall openings (402) so as not to block gas / oxygen supplied through the aperture (30) / connector (31 ). As shown, the openings (402) accommodate the various rotated positions of the endoscope guide (300A / 300B). It will be appreciated that there is passage for exhaled air, and for O2 (or other gas) from the bag apparatus into the lungs of the patient, around the peripheries of an inserted endoscope. For example, for exhaled air to reach the additional outlet opening (208) of a connector portion (204A, 204B) of a connected bag apparatus (when implemented), exhaled air may travelin through leading end opening of the endoscope guide (311 ), around the endoscope, then out through the connector (31 ) on funnel member (25A) to reach the opening (208). Similarly, the passage for received gas from a connected bag apparatus or other means would be similar but in the other direction. It will be appreciated that when no guide (e.g. 300A) or endoscope is inserted in the bite block, air / gas may still follow the passage through the connector (31 ) on funnel member.

[0183] It will be appreciated that, in some forms, the first portion (350) may have an additional secondary tubular portion, similar to that shown in Figure 10, which extends alongside the main tubular portion (301 ) to allow for insertion of a gastric tube.

[0184] It will also be appreciated that, like in previously described forms, an end closures that provides a seal around the endoscope, may be included. As shown in Figures 13, 17, 20, and 22, an end closure member (500) is fitted / formed in the second portion (450) of endoscope guide (300A / 300B) and is adapted to provide a sealing effect around the endoscope when inserted. The end closure member (500) comprises two slits that intersect to form an “X” shaped opening (501 ), providing four flexible tabs that bend to allow insertion of the endoscope. The end closure might alternatively comprise other forms, such as a form of one-way valve for the endoscope, opening to allow for insertion of the endoscope (or other instrument / apparatus) and providing a substantial seal therearound, and also more fully sealing / closing automatically once the endoscope / instrument is removed. It will also be appreciated that, in other forms, where an endoscope guide is not used, the end closure may be provided / fitted directly in the funnel member. In either case, it will be appreciated that an end closure needs to be positioned more outward than the aperture (30) in the wall of the funnel (i.e. more outward toward the endoscope insertion end of the funnel member as shown) to provide an appropriate seal such that gas / oxygen received through the connector does not escape / leak out through the main opening of the funnel.

[0185] To securely position and provide a seal around the endoscope guide (300B), once the leading end (305) thereof reaches the patient’s throat, a sealing element (600) may be provided at the first portion (350) of the endoscope guide (300B). As shown schematically in figures 31 and 32, the sealing element (600) may comprise an inflatable balloon or cuff (601 ) extending around the endoscope guide (300B) at the leading end (305) of the first portion (350). The balloon or cuff is inflated to provide a seal around the endoscope guide (300B) in seeking to ensure that exhaled air flows into the leading end(305) of the endoscope guide (300B). Figure 31 schematically illustrates the deflated form of the cuff (601 ), while Figure 32 schematically illustrates the inflated form of the cuff (601 ). Inflation may for example be carried out through a tube running along the side of the endoscope guide (300B). In some forms, to still allow for passage of exhaled air through the nose of the patient, the endoscope guide (typically the leading end thereof) may include apertures therein.

[0186] Another variation of the leading end (305) for endoscope guides as described herein is shown in figures 33 and 34. As shown, the leading end (305) widens at the leading end tip thereof, so as to provide a larger mouth / opening (311 ) at the leading end (305). Again, the mouth / opening (31 1 ) is at a side of the leading end (305) (relative to the elongate axis of the guide (300C)). The ‘closed’ or ‘walled’ side of the leading end (305) includes elongate apertures (313) therein to allow for escape of exhaled air into the oral cavity and out through the nose of the patient. The widened tip may also be flexible yet resilient to allow for insertion, secure positioning, and to provide some sealing effect (on the basis of the resilient nature thereof).

[0187] Yet a further variation of the bite block according to the invention is illustrated in figures 35 to 47. In this example, rather than being provided by a rotating retaining member, the retaining means comprises two arms (1016a, 1016b), which are movable between a retracted position (see e.g. Figs. 42 and 43) and a deployed position (see e.g. Fig. 35). The retracted position provides the fitting position or configuration, wherein the arms (1016a, 1016b) extend into the passage (1003) of the bite block body (1002), providing minimal interference for insertion into the patient's mouth.

[0188] Once the bite block body (1002) is in the fitted position, the arms (1016a, 1016b) are moved into the deployed position to anchor the bite block (1001 ) in the patient’s mouth. The arms (1016a, 1016b) hook behind the patient's teeth, such that the bite block cannot easily be dislodged. That is, the deployed position provides the retaining position or configuration. It will be appreciated that in the deployed configuration, at least a portion of the arms (1016a, 1016b) extend outwardly from the bite block body (1002), and in particular, outwardly with respect to the upper and lower outer biting surfaces (1010, 101 1 ) of bite barrier portion (1008).

[0189] The arms (1016a, 1016b) are biased into, or rest in, the retracted position such that they can then be flexed into the deployed position. In particular, at least at theirbase, they are formed of a material (typically a polymeric material) that is resilient but allows for flexion into the deployed position. Flexion is typically encouraged by a thinning in the area where the base of the arms (1016a, 1016b) meets the remainder of the bite block body (1002).

[0190] Movement into the deployed position is actuated by insertion of an insert in the form of an endoscope guide (1300). As the guide (1300) is inserted, the arms (1016a, 1016b) are pushed outwardly from within the passage (1003) such that the arm free ends (1017a, 1017b) protrude with respect to the upper and lower biting surfaces (1010, 1011 ). When the insert (1300) is removed, the arms (1016a, 1016b) return to the retracted position to allow for removal of the bite block body (1002). As described previously, in respect of other embodiments, the endoscope guide (1300) additionally facilitates insertion of the endoscope through the bite block (1001 ), and also, directs or guides the endoscope down the patient’s throat.

[0191] The arms (1016a, 1016b) are provided by tongues (1402a, 1402b) formed in the wall (1401 ) of the bite block passage (1003), at the upper and lower outer biting surfaces (1010,101 1 ) of the bite barrier portion (1008). As shown, the arms (1016a, 1016b) are bent outwardly at their free ends (1017a, 1017b), to provide protruding regions (1023, 1024) that hook behind the patient’s teeth when deployed. In the deployed position, the remainder of the arms (1016a, 1016b) sit substantially flush with the upper and / or lower biting surfaces (1010, 101 1 ), and form part thereof. In some forms (not shown) a tubular sleeve may be placed around bite barrier portion (1008), to provide a continuous biting surface of the bite barrier portion (1008) which might otherwise be discontinuous due to the formation of the tongues (1402a, 1402b), i.e. in the upper and lower outer biting surfaces (1010, 1011 ). The sleeve may be formed of a softer and / or spongier material that than remainder of the bite block body (1002), in seeking to more conformably accommodate the patients’ teeth, and avoid damage thereto.

[0192] The endoscope guide / insert (1300) when inserted, maintains the arms (1016a, 1016b) in the deployed position, but also, the restoring force of the arms (1016a, 1016b) supports retention of the endoscope guide / insert (1300) within the passage (1003) of the bite block body (1002).

[0193] As shown, the insert / endoscope guide (1300) is substantially elongate, tubular and straight along its length, but has a leading end (1305) that opens to the sidewith respect to the longitudinal axis of the guide (1300). As described previously, this provides a curved endoscope path at the leading end (1305) to help direct / guide the endoscope down the patient’s throat. Le. an end wall (1310) at the leading end (1305) directs the endoscope out through the side opening (1311 ).

[0194] The tailing end (1306) of the insert / endoscope guide (1300), which protrudes from the second end of the body (1007) when inserted, includes a funnel (1025) to guide subsequent insertion of an endoscope. Also, as with other forms previously described, the insert includes an aperture (1030) in a side wall (1026) at the tailing end (1306), and a connector (1031 ) extending from the side wall (1301 ) at the aperture for connection with a gas supply device or related apparatus. The connector (1031 ) is a tubular extension that extends from a rim of the aperture (1030). In this way oxygen or other gas can be applied to the patient from a gas supply device as previously described, optionally in combination with a bag apparatus as also previously described.

[0195] It will be appreciated that the insert may take other forms, or the arms may alternatively be positioned using a medical instrument.

[0196] It will also be appreciated that other aspects common with the other embodiments, such as the wall portion (9 / 1009), or end closure (500 / 1500) provide analogous functionality to previously described forms.

[0197] For example, as with some earlier described forms, the end closure (1500) comprises two slits that intersect to form an “X” shaped opening (1501 ), providing four flexible tabs that bend to allow insertion of the endoscope and provide a substantial seal around the endoscope when inserted.

[0198] Again, as with the other forms, the body includes a wall portion (1009) configured to be located between the teeth and lips of the patient, when the bite block (1001 ) is in the fitted position. The wall portion (1009) is shaped to provide a sealing effect with respect to the mouth opening of the patient. With respect to the direction from the first end (1005) of the body (1002) to the second end (1007) of the body (1002), the wall portion (1009) extends laterally from the bite barrier portion (1008) at the second end (1007) (i.e. end region) of the body (1002). The wall portion (1009) is substantially U or C-shaped, providing opposing arms (1014, 1015), the opposing arms (1014, 1015) extending initially laterally from the bite barrier portion (1008) at the second end (1007) of the body (1002) and then in the direction of the first end (1005) of the body (1002).

[0199] The passage (1003) and insert (1300) are both typically substantially cylindrical such that when inserted the insert / guide (1300) is concentrically fitted within the passage (1003) as such that it can rotate therein. To limit rotation, the bite block (1001 ) further includes a recess / indentation (1021 ) at the second end (1007) of the body (1002), that defines side walls (1021 a, 1021b). The endoscope guide (1300) includes a protrusion (1022) that is received in the recess / indentation (1021 ) when the guide (1300) is inserted into the body (1002). As the guide (1300) is thereafter rotated, the protrusion (1022) abuts the side walls (1021 a), such that rotation is limited. It will be appreciated that rotation allows for the insert / endoscope guide (1300) to be inserted such that the leading end opening (131 1 ) does not directly face and therefore catch or hook the patient’s tongue on insertion. After insertion the insert / guide (1300) can be rotated, for example, from facing the patient’s cheek to facing down the patient’s throat i.e. ready for the procedure. Typically, rotation is limited, about an angle of about 90e.

[0200] Figures 53 to 64 show yet a further variation of the bite block (1001 A) according to the invention. In this form, the bite block body (1002A) and endoscope guide / insert (1300A) have slight modifications when compared to the bite block body (1002) and endoscope guide / insert (1300) shown in figures 35 to 47. Like numerals have been used to described like parts, and common aspects have not been described hereinafter.

[0201] With respect to the differences, the bite block body (1002A) includes a second recess / indentation (1029) at the second end (1007) thereof, that defines side walls (1029a, 1029b). As shown in figures 61 to 64, the second recess / indentation (1029) is located opposite the first recess / indentation (1021 ). When the insert / guide (1300A) is inserted into the bite block body (1002A), the protrusion (1022) may be alternatively received in the second recess / indentation (1029) instead of the first recess / indentation (1021 ). As discussed previously with respect to the first recess / indentation (1021 ), rotation of the guide (1300A) is limited by abutment of the protrusion (1022) with the side walls (1029a, 1029b). Having two recesses / indentations (1021 , 1029), allows for more flexibility in the way the insert / endoscope guide is inserted into the body (1002A), e.g. to accommodate the patient lying on different sides. It will be appreciated that each indentation typically allows for rotation about an angle of about 90°.

[0202] The endoscope guide / insert (1300A) is varied in that it includes a groove (1320) configured to receive the bend portions / elbows (1018a, 1018b) of the arms(1016a, 1016b) of the bite block body (1002A), when the endoscope guide / insert (1300A) is inserted into the bite block body (1002A). The groove (1320) provides for more secure positioning of the insert (1300A) within the passage (1003). Once the bend portions / elbows (1018a, 1018b) of the arms (1016a, 1016b) are positioned in the groove (1320), movement of the insert (1300A) in and out of the bite block passage (1003) is more difficult. This is typically helpful during procedures, as endoscopes are usually moved in and out and jiggled, and so having the arms (1016a, 1016b) engage with a groove (1320) provides for additional stability and engagement between the bite block body (1002A) and the endoscope guide / insert (1300A).

[0203] As shown in figures 56 to 59, the groove (1320) typically extends all the way around the circumference of the endoscope guide / insert (1300A). This allows for the bend portions / elbows (11 18a, 11 18b) of the arms (1016a, 1016b) to move freely along the groove (1320), when the guide / insert (1300A) is rotated. It will be appreciated that in alternate forms, a broken / discontinuous groove may be used (i.e. partial grooves around the circumference), in which the ends of each partial groove may prevent over rotation of the endoscope guide / insert by abutment with the elbows (e.g. so a protrusion and accommodating recesses / indentations may not be needed). As shown, the elbows (1018a, 1018b) and free ends (1017a, 1017b) of the arms (1016a, 1016b) may be thickened, such that in the deployed position, when the elbows (1018a, 1018b) are in the grooves (1320), the remainder / base portions of the arms (1016a, 1016b) still sit substantially flush with the top and bottom outer biting surfaces (1010, 101 1 ). In addition, as shown, the insert (1300A) may be thickened in the region immediately before and after the groove (1320), to allow the groove (1320) to be deeper, to provide more secure engagement with the elbows (1018a, 1018b).

[0204] It will be appreciated that in some forms, in the retracted position or after failing to fully return thereto, the arms (1016a, 1016b) may not completely or fully extend into the passage (1003) i.e. the tips of the outwardly bent free ends (1017a, 1017b) (which form the protruding regions that hook behind the patients’ teeth in the deployed position) might protrude a little from the passage. As such, in the form as shown in figures 53 to 64 the angle of the bend in the arms (1016a, 1016b) is such the ends (1017a, 1017b) are sloped to extend in a direction away from the second end (1007) of the body (i.e. the angle of the bend is over 90e). This provides that if there is contact with the back of the teeth on removal from the bite block body (1002A), the teeth more readily slide along theslope, pushing the arms (1017a, 1017b) into the passage (1003), to facilitate removal. The slope also facilitates removal in the event the arms (1017a, 1017b) fail to retract from the deployed position after removal on the insert / endoscope (1300A) (e.g. if the material of the arms starts to fatigue and fails thereafter be resilient). It will be appreciated that this effect would still be provided, although to a lesser extent, where there might be some protrusion of the tips in the retracted position in forms with a sharper angle / bend (e.g. as shown in figures 35 to 47, wherein the angle may for example be about 90e), due to the typical rest or default position of the overall arms when in the retracted position.

[0205] It is also appreciated that the leading end opening (1311 ) on the insert / endoscope guide (1300A) is formed by more of a scooped cut-out, than the form shown in figures 35 to 47 which is formed by more of a straight cut.

[0206] The bite blocks as described herein, which as described may be used with an endoscope guide and / or bag apparatus, may also be used to apply intermittent positive pressure ventilation and / or gas anaesthetic via the connector (or directly through the relevant aperture in cases where connector may not be included). For example, in cases where the endoscope is removed, a cap may be fitted to any one of: the passage of the bite block body; a funnel (e.g. 25) ( e.g. at position (44)); or the tailing end of an endoscope guide (e.g. 300) or insert (e.g. 1300), so as to prevent the escape of gas from the oral cavity, when gas (e.g. oxygen / anaesthetic) is applied through the connector (or through the relevant aperture). Alternatively, in embodiments where the partition / end closure(s) is / are configured to automatically close on removal of the endoscope e.g. in the one way valve type forms described, an additional cap may not be required due to sufficient sealing already being provided. It will also be appreciated that when intermittent positive pressure ventilation and / or gas anaesthetic is applied, a nose clip is typically placed over the patient’s nose, to block the escape of gas out through the nose. It will also be appreciated that exhaled gas is typically received back into the ventilation / anaesthetic machine also via the connector / aperture. In some cases, to provide additional sealing, tape may be additionally applied over the lips of the patient.

[0207] It will also be appreciated the bite blocks as described herein typically allow for one or more of the following advantageous aspects:- being easy to insert and not prone to falling out during procedures, as they are secured, with no need for taping or staff to hold;- inflation and deflation of the bag apparatus I reservoir bag can indicate patient’s breathing cycles and depth of breathing;- in typical use oxygen supplied will reach the laryngeal area within the pharynx as there is no other outlet for it to escape from the point of supply to the vicinity of the larynx;- in typical use the reservoir bag filled with oxygen empties into the airway at the beginning of every inspiratory cycle thereby enriching the pharynx with oxygen before air dilution happens with the air entering through the nasal passages;- on typical use oxygen concentration will remain high close to the larynx all through the procedure preventing hypoxia;- when compared to the use of conventional high flow equipment, the bite blocks are inexpensive to produce and may only require 2-4 litres of Oxygen per minute to achieve optimal Oxygen saturation instead of 40 litres of Oxygen required per minute with high flow equipment. Over and above the volume of Oxygen that is wasted with high flow equipment, there is also the additional cost of the reusable and disposable equipment and related maintenance costs;- there is no need for an additional power supply.

[0208] It will also be appreciated that the various components of the bite blocks / bite block assemblies as described herein e.g. bite block bodies, inserts / endoscope guides, are typically formed of polymer / plastic materials. For examples, in the embodiment of figures 53-64, the bite block body (1002A) may be formed in some examples of polypropylene, polyurethane or nylon, whereas the insert / endoscope guide may be formed in some examples of polyvinyl chloride, acrylonitrile butadiene styrene or polycarbonate.

[0209] It will be appreciated to a skilled person that various elements from the different embodiments described herein may be readily combined as appropriate.

[0210] Throughout this specification and the claims which follow, unless the context requires otherwise, the word “comprise”, and variations such as “comprises” or “comprising”, will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps.TABLE OF REFERENCE NUMERALS1 Bite Block1A Bite Block2 Bite Block Body3 Passage4 First End Opening5 First End6 Second End Opening7 Second End8 Bite Barrier Portion9 Wall Portion9a, 9b Main Faces10 Top Outer Biting Surface11 Bottom Outer Biting Surface12, 13 Outer Side Surfaces14, 15 Opposing Arms16 Retaining Member17 Anchor Portion18 Tubular Portion19 Inner Wall Surface20 Outer Wall Surface21 Recesses21a Side Walls22 Protrusions23, 24 End / Tab Portions25 Funnel25A Funnel MemberTubular Portion A Neck RegionOuter Wall SurfaceProtrusionsInner Wall SurfaceApertureConnector / tubular extension / 42 Partition / end closureFunnel flangePosition 1 Nasal Cavity 2 Upper Lip 3 Lower Lip 4 Lower Teeth 5 Flange 6 Airway 7 Oral Cavity 8 Tongue 9 Larynx 0 Trachea 1 Hard Palate 2 Nasopharynx 3 Soft Palate 4 Oropharynx 5 Oropharynx 6 Laryngopharynx 7 Oesophagus 8 FunnelBite Block BodyEpiglottisUpper TeethLower Gum AreaBag ApparatusInflatable Bag PortionInlet D InletOutletConnector Portion or T-connectorA Connector Portion B Connector Portion C Connector Portion D Connector Portion A Tubular Member B Hole C Cap / End Portion D Cap / End Portion C Openings D OpeningsOutlet / OpeningInternal WallEnd Closure Member C Inlet OpeningD Inlet OpeningEndoscope Guide A Endoscope Guide B Endoscope GuideTubular PortionUpper / Lower Wall PortionsSide Wall PortionsAperturesLeading EndTailing EndTailing End FlangeSecondary Tube Portion, 312 End OpeningsElongate AperturesFirst PortionHandleSide Wall OpeningsLeading EndTailing EndSecond PortionEnd Closure Member“X” Shaped OpeningSealing Element601 Inflatable Balloon or Cuff602 Pilot Cuff603 Valve1001 Bite Block1001A Bite Block1002 Bite Block Body1002A Bite Block Body1003 Passage1005 First End1007 Second End1008 Bite Barrier Portion1009 Wall Portion1010 Top Outer Biting Surface101 1 Bottom Outer Biting Surface1012, 1013 Outer Side Surfaces1014, 1015 Opposing Arms1016a, 1016b Arms1017a, 1017b Free Ends1018a, 1018b Elbows / Bend Portions1021 Recess1021 a, 1021 b Side Walls1023, 1024 Protruding Regions1022 Protrusion1025 Funnel Member1026 Side Wall / Tubular Portion1029 Recess1029a, 1029b Side Walls1030 Aperture1031 Connector1300 Endoscope Guide / lnsert1300A Endoscope Guide / lnsert1305 Leading End1306 Tailing End131 1 End / Side Opening1320 Groove1401 Wall of Bite Block Passage1402a, 1402b Tongues1500 End Closure Member1501 “X” Shaped OpeningP Plane

Claims

Claims1 . An endoscopic bite block including: a body with a bite barrier portion to be located between the upper and lower teeth of a patient when the bite block is in a fitted position, the body having a passage therethrough for insertion of an endoscope, the passage extending between an opening at a first end of the body and an opening at a second end of the body, and in the fitted position of the bite block, the first end is located behind the teeth of the patient and the second end is located in front of the teeth of the patient; and a retaining means configurable between a fitting position or configuration, which facilitates fitting of the bite block into the fitted position, and a retaining position or configuration, which facilitates retainment of the bite block in the fitted position.

2. An endoscopic bite block as claimed in claim 1 , wherein the retaining means is a retaining member that is coupled to the body such that it can rotate with respect to the body, between fitting and retaining positions.

3. An endoscopic bite block as claimed in claim 2, wherein the retaining member provides an anchor portion at the first end of the body.

4. An endoscopic bite block as claimed in claim 3, wherein the anchor portion is in the form of an elongate element.

5. An endoscopic bite block as claimed in claim 4, wherein the elongate element has two ends which each extend laterally with respect to the direction from the first end to the second end of the body, in generally opposite directions.

6. An endoscopic bite block as claimed in claim 5, wherein the ends of the elongate element are curved in a direction away from the body.

7. An endoscopic bite block as claimed in claim 5 or 6, wherein the ends of the elongate element provide tab portions.

8. An endoscopic bite block as claimed in any one claims 2 to 7, wherein the passage includes a partition therein and / or end closure, the partition and / or end closure having an expandable opening for receiving the endoscope therethrough, so as to provide a substantial seal around the endoscope when inserted.

9. An endoscopic bite block as claimed in any one of claims 2 to 8, wherein the passage includes a partition therein and / or end closure, the partition and / or end closure configured to be openable to allow for insertion of the endoscope through the passage, and also configured to close once the endoscope is removed.

10. An endoscopic bite block as claimed in claim 9, wherein the partition and / or end closure provides a substantially seal around the endoscope when inserted.1 1. An endoscopic bite block as claimed in any one of claims 2 to 10, wherein the passage is substantially cylindrical.

12. An endoscopic bite block as claimed in claim 1 1 , wherein the retaining member includes a substantially tubular portion, the tubular portion fitted concentrically within the passage such that it can rotate therewithin.

13. An endoscopic bite block as claimed in claim 12, wherein an inner wall surface of the passage and an outer wall surface of the tubular portion have cooperating formations thereon that prohibit over-rotation of the retaining member beyond the fitting and retaining positions.

14. An endoscopic bite block as claimed in any one of claim 2 to 13, wherein the body further includes a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position.

15. An endoscopic bite block as claimed in claim 14, wherein the wall portion is shaped to provide a sealing effect with respect to the mouth opening of the patient.

16. An endoscopic bite block as claimed in claim 14 or 15, wherein, with respect to the direction from the first end of the body to the second end of the body, the wall portion extends laterally from the bite barrier portion at the second end of the body.

17. An endoscopic bite block as claimed in claim 16, wherein the wall portion is substantially U or C-shaped, providing opposing arms, the arms extending initially laterally from the bite barrier portion at the second end of the body and then in the direction of the first end of the body.

18. An endoscopic bite block as claimed in claim 17, wherein one of the arms includes an aperture therein.

19. An endoscopic bite block as claimed in claim 18, wherein the wall portion includes main faces that are solid apart from the aperture.

20. An endoscopic bite block as claimed in claim 18 or 19, including a connector at the aperture.21 . An endoscopic bite block as claimed in claim 20, wherein the connector is a tubular extension that extends from a rim of the aperture.

22. An endoscopic bite block as claimed in any one of claims 17 to 21 , wherein, in the fitting position of the retaining member, the elongate element has a direction of elongation that is in the plane of the opposing arms of the wall portion, and in the retaining position of the retaining member, the elongate element has a direction of elongation that is angled with respect to the plane of the opposing arms of the wall portion.

23. An endoscopic bite block as claimed in claim 22, wherein, in the retaining position of the retaining member, the elongate element has a direction of elongation that is substantially perpendicular to the plane of the opposing arms of the wall portion.

24. An endoscopic bite block as claimed in any one of claims 5 to 8, wherein, with respect to a fitted position of the bite block, when the retaining member is in the fitting position the elongate element has a direction of elongation that is parallel to the transverse plane of the patient, and when the retaining member is in the retaining position the elongate element has a direction of elongation that is perpendicular to the transverse plane of the patient.

25. An endoscopic bite block as claimed in any one of claims 2 to 24, wherein the bite barrier portion includes substantially parallel top and bottom outer biting surfaces.

26. An endoscopic bite block as claimed in claim 12 or 13, wherein the retaining member includes a handle portion that extends from the tubular portion at the second end of the body and outside the passage.

27. An endoscopic bite block as claimed in any one of claims 2 to 26, wherein the bite block includes a funnel at the second end of the body to guide insertion of an endoscope into the passage opening at the second end of the body.

28. An endoscopic bite block as claimed in claim 27, wherein the funnel is part of a funnel member.

29. An endoscopic bite block as claimed in claim 28, wherein the funnel member includes a tubular portion that is concentrically fitted within the tubular portion of the retaining member.

30. An endoscopic bite block as claimed in claim 28 or 29, wherein the funnel member includes an aperture in a wall thereof.

31. An endoscopic bite block as claimed in claim 30, wherein the funnel member includes a neck region that protrudes from the second end of the body.

32. An endoscopic bite block as claimed in claim 31 , wherein the aperture in the wall of the funnel member is disposed at the neck region of the funnel member.

33. An endoscopic bite block as claimed in any one of claims 30 to 32, wherein the funnel member includes a connector at the aperture in the wall of the funnel member.

34. An endoscopic bite block as claimed in claim 33, wherein the connector is a tubular extension that extends from a rim of the aperture in the wall of the funnel member.

35. An endoscopic bite block as claimed in claim 1 , wherein the retaining means includes at least one arm movable between a retracted position and a deployed position, wherein the retracted position provides the fitting position or configuration, and the deployed position provides the retaining position or configuration.

36. An endoscopic bite block as claimed in claim 35, wherein in the retracted position, the at least one arm extends into the passage.

37. An endoscopic bite block as claimed in claim 35 or 36, wherein the at least one arm is biased to the retracted position.

38. An endoscopic bite block as claimed in any one of claims 35 to 37, wherein the at least one arm is provided by a tongue formed in a wall of the passage.

39. An endoscopic bite block as claimed in any one of claims 35 to 38, wherein in the deployed position, at least a portion of the at least one arm extends outward from body.

40. An endoscopic bite block as claimed in any one of claims 35 to 39, wherein the bite barrier portion provides upper and lower outer biting surfaces, and the at least one arm is formed in the upper and / or lower outer biting surfaces.

41. An endoscopic bite block as claimed in claim 40, wherein the at least one arm is bent at a free end thereof, to provide a region of the at least one arm that protrudes with respect to the upper and lower outer biting surfaces when the at least one arm is in the deployed position, the remainder of the at least one arm sitting substantially flush with the upper and / or lower biting surfaces.

42. An endoscopic bite block as claimed in any one of claims 35 to 41 , wherein the at least one arm is two arms.

43. An endoscopic bite block as claimed in any one of claims 35 to 42, wherein the bite block includes an insert to be received in the passage such that when inserted, the at least one arm is maintained in the deployed position.

44. An endoscopic bite block as claimed in claim 43, wherein the insert is an endoscope guide.

45. An endoscopic bite block as claimed in claim 43 or 44, wherein the insert is elongate and tubular.

46. An endoscopic bite block as claimed in any one of claims 43 to 45, wherein the insert includes a tailing end that protrudes from a second end of the body when inserted therein.

47. An endoscopic bite block as claimed in claim 46, wherein the insert has a funnel at the tailing end, to guide insertion of an endoscope.

48. An endoscopic bite block as claimed in claim 46 or 47, wherein the insert includes an aperture in a side wall of the tailing end.

49. An endoscopic bite block as claimed in claim 48, wherein the insert includes a connector at the aperture in the side wall of the tailing end.

50. An endoscopic bite block as claimed in claim 49, wherein the connector is a tubular extension that extends from a rim of the aperture.

51. An endoscopic bite block as claimed in any one of claims 43 to 50, wherein the insert includes a leading end that protrudes from the first end of the body when inserted therein.

52. An endoscopic bite block as claimed in claim 51 , wherein the insert is substantially straight along its length.

53. An endoscopic bite block as claimed in claim 52, wherein the leading end opens to the side with respect to the longitudinal axis of the insert.

54. An endoscopic bite block as claimed in any one of claims 43 to 53, wherein the insert includes a partition therein and / or end closure, the partition and / or end closure having an expandable opening for receiving the endoscope therethrough, so as to provide a substantial seal around the endoscope when inserted.

55. An endoscopic bite block as claimed in any one of claims 43 to 53, wherein the insert includes a partition therein and / or end closure, the partition and / or end closure configured to be openable to allow for insertion of the endoscope therethrough, and also configured to close once the endoscope is removed.

56. An endoscopic bite block as claimed in claim 55, wherein the partition and / or end closure provides a substantial seal around the endoscope when inserted.

57. An endoscopic bite block as claimed in any one of claims 43 to 56, wherein the passage is substantially cylindrical and the insert when inserted is fitted concentrically within the passage such that it can rotate therewithin.

58. An endoscopic bite block as claimed in claim 57, wherein the body and the insert each have cooperating formations that limit rotation of the insert when inserted in the body.

59. An endoscopic bite block as claimed in any one of claims 35 to 58, wherein the body further includes a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position.

60. An endoscopic bite block as claimed in claim 59, wherein the wall portion is shaped to provide a sealing effect with respect to the mouth opening of the patient.61 . An endoscopic bite block as claimed in claim 59 or 60, wherein, with respect to the direction from the first end of the body to the second end of the body, the wall portion extends laterally from the bite barrier portion at the second end of the body.

62. An endoscopic bite block as claimed in any one of claims 59 to 61 , wherein the wall portion is substantially U or C-shaped, providing opposing arms, the opposing arms extending initially laterally from the bite barrier portion at the second end of the body and then in the direction of the first end of the body.

63. An endoscopic bite block including a body with a bite barrier portion to be located between the upper and lower teeth of a patient when the bite block is in a fitted position, the body having a passage therethrough for insertion of an endoscope, wherein the passage extends between an opening at a first end of the body and an opening at a second end of the body, and in the fitted position of the bite block, the first end is located behind the teeth of the patient and the second end is located in front of the teeth of the patient, the body further including a wall portion configured to be located between the teeth and lips of the patient, when the bite block is in the fitted position.

64. An endoscopic bite block as claimed in claim 63, wherein the wall portion is shaped to provide a seal effect with respect to the mouth opening of the patient.

65. An endoscopic bite block as claimed in claim 63 or 64, wherein the wall portion includes an aperture therein.

66. An endoscopic bite block as claimed in claim 65, wherein the wall portion includes main faces that are solid apart from the aperture.

67. An endoscopic bite block as claimed in claim 65 or 66, including a connector at the aperture.

68. An endoscopic bite block as claimed in claim 67, wherein the connector is a tubular extension that extends from a rim of the aperture.

69. An endoscopic bite block as claimed in any one of claims 63 to 68, wherein, with respect to the direction from the first end of the body to the second end of the body, the wall portion extends laterally from the bite barrier portion at the second end of the body.

70. An endoscopic bite block as claimed in any one of claims 63 to 69, wherein the wall portion is substantially U or C-shaped providing opposing arms, the arms extending initially laterally from the bite barrier at the second end of the body, and then in the direction of the first end of the body.71 . An endoscopic bite block as claimed in claim 70, wherein one of the arms includes the aperture therein.

72. An endoscopic bite block as claimed in any one of claims 63 or 64, wherein the bite block includes a funnel at the second end of the body to guide insertion of an endoscope into the passage opening at the second end of the body.

73. An endoscopic bite block as claimed in claim 72, wherein the funnel is part of a funnel member that is fitted to the body.

74. An endoscopic bite block as claimed in claim 73, wherein the funnel member includes a tubular portion that is concentrically fitted within the passage.

75. An endoscopic bite block as claimed in claim 73 or 74, wherein the funnel includes an aperture in a wall thereof.

76. An endoscopic bite block as claimed in claim 75, wherein the funnel includes a neck region that protrudes from the second end of the body.

77. An endoscopic bite block as claimed in claim 76, wherein the aperture in the wall of the funnel member is disposed at the neck region of the funnel member.

78. An endoscopic bite block as claimed in any one of claims 75 to 77, wherein the funnel member includes a connector at the aperture in the wall of the funnel member.

79. An endoscopic bite block as claimed in claim 78, wherein the connector is a tubular extension that extends from a rim of the aperture in the wall of the funnel member.

80. An endoscopic bite block as claimed in any one of claims 63 or 64, further including an insert to be received in the passage, the insert being substantially tubular and elongate, and having a tailing end that protrudes from the second end of the body when inserted, and wherein, a side wall of the tailing end includes an aperture therein.81 . An endoscopic bite block as claimed in claim 80, wherein the insert includes a connector at the aperture.

82. An endoscopic bite block as claimed in claim 81 , wherein the connector is a tubular extension that extends from a rim of the aperture in the side wall of the insert.

83. An endoscopic bite block assembly including: a bite block as claimed in any one of claims 20, 21 , 33, 34, 49, 50, 67, 68, 78, 79, 81 or 82; and a bag apparatus comprising an inflatable bag, an outlet connected with the connector of the bite block, and an inlet for connection with a gas supply.

84. A method of administering oxygen to a patient during an endoscopic procedure wherein the endoscope is inserted through the mouth including: fitting a bite block assembly according to claim 83 to a patient; and supplying oxygen to the patient via the inlet of the bag apparatus.

85. An endoscopic bite block kit, including: a bite block as claimed in claim 20, 21 , 33, 34, 49, 50, 67, 68, 78, 79, 81 or 82; and a bag apparatus comprising an inflatable bag, an outlet for connection with the connector of the bite block, and an inlet for connection with a gas supply.

86. An endoscope guide for insertion though an endoscope passage in an endoscopic bite block, the guide comprising a tubular passage that extends between two end openings, the tubular passage having a wall with one or more apertures therein.

87. An endoscope guide as claimed in claim 86, wherein the guide is elongate and curved at least along a portion of its length.

88. An endoscope guide as claimed in claim 86 or 87, wherein at least a portion thereof is elastically deformable.

89. An endoscope guide as claimed in any one of claims 86 to 88, wherein the endoscope guide includes a leading end to be inserted through the endoscope passage, and a tailing end, the tailing end including a stop extending therefrom configured to prohibit the tailing end from passing through the endoscope passage.

90. An endoscope guide as claimed in claim 89, wherein the leading end is more flexible than the tailing end.91 . An endoscope guide for insertion though an endoscope passage in an endoscopic bite block, the guide comprising first and second portions wherein the first portionprovides a substantially tubular passage to guide the endoscope, and the second portion provides a stop that prohibits the second portion from passing through the endoscope passage.

92. An endoscope guide as claimed in claim 91 , wherein the first portion is substantially straight along its length but has a leading end that opens to the side with respect to the longitudinal axis of the first portion.

93. An endoscope guide as claimed in claim 91 or 92, wherein the first and second portions of the guide are connected by snap fitting the first portion with the second portion.

94. An endoscope guide as claimed in claim 91 or 92, wherein the first and second portions of the guide are integrally formed with one another.

95. An endoscope guide for insertion though an endoscope passage in an endoscopic bite block, the insert being elongate and substantially tubular, the insert including a leading end to be inserted through the endoscope passage, and a tailing end that protrudes from the endoscope passage when inserted.

96. An endoscope guide as claimed in claim 95, wherein the insert has a funnel at the tailing end, to guide insertion of an endoscope.

97. An endoscope guide as claimed in claim 95 or 96, wherein the insert is substantially straight along its length and has a leading end that opens to the side with respect to the longitudinal axis of the insert.

98. An endoscope guide as claimed in any one of claims 95 to 97, wherein a side wall of the tailing end includes an aperture therein.

99. An endoscope guide as claimed in claim 98, including a connector at the aperture.

100. An endoscope guide as claimed in claim 99, wherein the connector is a tubular extension that extends from a rim of the aperture in the side wall of the insert.

101. An endoscopic bite block assembly including: a bite block as claimed in any one of claims 1 to 42, 59 to 79; and an endoscope guide as claimed in any one of claims 86 to 100.

102. An endoscopic bite block kit including: a bite block as claimed in any one of claims 1 to 42, 59 to 79; andan endoscope guide as claimed in any one of claims 86 to 100.

103. An endoscopic bite block assembly as claimed in claim 83, further including an endoscope guide as claimed in any one of claims 86 to 100.

104. An endoscopic bite block kit as claimed in claim 85, further including an endoscope guide as claimed in any one of claims 86 to 100.

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