Bite block assembly

Abstract

The invention relates to a bite block assembly (1) for endoscopic procedures, the bite block assembly comprising the following features: a) a bite block (2) comprising: a front face (6) facing away from the oral cavity (5) of a patient; a rear face (7) facing the oral cavity; and upper and lower face biting surfaces (8, 9); wherein a bite block opening (10) extends, from the front face to the rear face, through the bite block and is designed to receive a longitudinally extending insert; b) the longitudinally extending insert (3) has at its proximal end (12) an insertion head (13), which can be clampingly inserted into the bite block opening, and an arcuate portion (17), which adjoins the insertion head and is atraumatically rounded in order to protect the palate, wherein the rounded arcuate portion has a distal end orientated with respect to the air tube; c) the arcuate portion has along its longitudinal extent a palatinal web element (20) for protecting the palate and the rear wall (18) of the throat, and has, on the buccal side of the palatinal web element, at least one jet channel (22), extending from the insertion head to the distal end (21), for respiratory air; d) the insertion head has a central longitudinal channel (23), wherein the longitudinal channel is open at an edge face (24) of the insertion head.

Description

[0001] Bite block arrangement

[0002] The invention relates to a bite block arrangement according to the features of patent claim 1.

[0003] Bite blocks are used to facilitate the passage of an endoscope during gastroscopy or bronchoscopy. Forceful manipulation or excessively thick or non-lubricated tubes generally pose a risk of injury to the pharyngeal wall or perforation, especially when using rigid endoscopes, catheters, or stent delivery systems.

[0004] The invention is based on the object of providing an improved bite block assembly that reduces the risk of injury, simplifies endoscopy, and ensures a supply of breathing air or respiratory support. The invention is achieved by a bite block assembly having the features of patent claim 1.

[0005] The bite block assembly according to the invention is intended for endoscopy procedures, namely gastroscopy and bronchoscopy. The bite block assembly comprises a bite block and an elongated insert. The bite block, for placement between the teeth, has a front side facing away from the patient's oral cavity and a back side facing the oral cavity, as well as upper and lower biting surfaces. A bite block opening extends through the bite block from the front side to the back side. It serves to precisely accommodate the elongated insert.

[0006] The elongated insert has an insert head at its proximal end that clamps and inserts into the bite block opening. The insert head is positioned in the bite block opening in a positionally oriented and releasable manner. The position is oriented longitudinally, meaning the insertion depth is limited. Furthermore, the position is oriented with respect to rotation around the longitudinal axis, which is reliably prevented. The bite block opening is non-circular. The insert head cannot be rotated into the bite block opening.

[0007] It is possible for the insert head to fit positively into the bite block opening and be secured in the bite block opening, for example, by a type of snap connection. In this sense, the cross-section of the insert head is functionally matched to the cross-section of the bite block opening. In particular, the insert head and / or the bite block are made of a resilient material, especially plastic. The bite block assembly is preferably used only once. It is a disposable item. The insert head establishes the detachable connection between the bite block and the elongated insert.

[0008] The insert head is connected to an atraumatically rounded arch section oriented toward the patient's oral cavity to protect the palate. The rounded arch section has a distal end oriented toward the trachea. The curvature of the arch section is adapted to the anatomy of the palate. The arch section features a palatal ridge along its length to protect the palate and the posterior pharyngeal wall.

[0009] If the elongated insert is in the bite block, an endoscope can subsequently be inserted through the insert head and the bite block opening into the oral cavity, whereby the endoscope abuts the palatal bar of the arch section without the risk of injuring or even perforating the mucous membranes in the palate or pharynx.

[0010] Another special feature of the elongated insert is that it has at least one jet channel for breathing air, extending from the insert head to the distal end, laterally, i.e., buccal to the palatal bridge. Jet channels are preferably provided on both sides of the palatal bridge. The jet channels end at the distal end of the arch section, with the outlet openings always facing the trachea and, in particular, the glottis due to the curvature of the arch section. Breathing air can be supplied via the jet channel(s).

[0011] The insert head has a central longitudinal channel to accommodate the endoscope. The longitudinal channel is open at one edge of the insert head. The longitudinal channel, which is open at the edge, allows the elongated insert to be subsequently inserted into the oral cavity at any time, even if an endoscope has already been passed through the bite block. This is best done when the patient's gag reflex has been eliminated through deep sedation. Because the longitudinal channel in the insert head is open at the edge, an existing endoscope can be inserted into the longitudinal channel through a slot in the edge of the insert head. This step takes place outside the oral cavity. The curved section is then inserted into the oral cavity first. The insert head is moved lengthwise along the endoscope until the insert head is located in the bite block opening. The tongue is pressed down so that the passage for the endoscope and breathing remains clear.As soon as the sedation has been reduced and the patient wakes up, the inserted head is removed, although the bite block can remain for bite protection.

[0012] The slot through which the endoscope can be inserted into the longitudinal channel is preferably designed so that the endoscope cannot slip out of the longitudinal channel unhindered. The slot can, for example, be angled along the channel's length. The insert head can also be made of a resilient material, with the slot being narrower than the diameter of the endoscope. To insert the endoscope, the slot must be widened. The material of the head springs back, allowing the slot to return to its original width.

[0013] The bite block assembly according to the invention consists in particular of a bite block and a combination of several inserts with differing geometries and / or sizes. Different sizes are intended for different patients, e.g., children or adults. Different geometries can be determined by the intended use; for example, the curved section at its distal end can have a slightly different curvature depending on whether a bronchoscopy or a gastroscopy is to be performed.

[0014] The curved section primarily serves to guide the endoscope in a tissue-friendly manner. At the same time, the distal end serves to direct the air toward the glottis. Accordingly, depending on the application and patient, inserts with differing geometries or sizes are provided as a set with a standardized bite block.

[0015] The patient's respiratory support or ventilation is provided via at least one jet channel in the curved section. For this purpose, the insert head has a connection for jet ventilation. The connection is, in particular, a connector piece onto which a tube can be attached, which is connected to a ventilation unit.

[0016] The bite block assembly according to the invention advantageously has buccal cheek elements arranged along its arched section, so that the arched section is U-shaped in cross-section and open at the mandibular end. The arched section, which is open towards the tongue, fulfills additional functions: Firstly, the palate and the posterior pharyngeal wall are protected by the palatal bridge. Furthermore, a U-shaped channel, open at the mandibular end, is created via the buccal cheek elements, which serves as a guide channel for an endoscope. This channel can also be referred to as a working channel. Furthermore, the cheek elements can serve as bridge-shaped tongue depressors to keep the airway clear. Typically, a tongue depressor is a closed, spatula-like surface parallel to the surface of the tongue. However, the buccal cheek elements are assemblies that are angled relative to the palatal bridge, in particular at a 90° angle to the palatal bridge.These bar- or disc-shaped tongue hold-down devices press on the tongue with their free edge facing the tongue, thereby creating the working channel between the cheek elements.

[0017] The function of the tongue depressor can also be fulfilled if the cheek elements have buccal openings. The openings can be so large that they consist only of individual rod- or bar-shaped cheek elements, which are attached to the insert head at their proximal ends and connected to the palatal bar at their distal ends at a distance from the insert head. If the elongated insert has the buccal wall elements, the slot in the insert head connected to the longitudinal channel is preferably located in a mandibular region of the insert head. If there are no such wall elements, the said slot can also be arranged buccally. Alternatively, at least one lingual bar is located on the insert head at a distance from the palatal bar as a tongue depressor. The palatal bar and the lingual bar are not connected to each other, but are only connected to the insert head via their proximal ends.In this case, an endoscope cannot be inserted from the mandibular side of the insert head into the central longitudinal channel of the insert head. Consequently, in this embodiment, the slot is positioned buccally, allowing the endoscope to be inserted laterally between the palatal bar and the lingual bar. If two parallel lingual bars are provided as tongue depressors, the slot can again be positioned mandibularly.

[0018] In an advantageous further development of the invention, at least one suction channel for fluids is arranged in the tongue depressor, more precisely in at least one of the cheek elements, preferably in both cheek elements. Suctioning the fluids reduces the risk of fluids from the oral cavity being entrained by the jet stream and entering the lungs.

[0019] The insert according to the invention is preferably made of a plastic that is intended for single use. The curved section can accordingly have a predetermined elasticity that is sufficient so that, when used as intended, the curved section is slightly bent relative to the insert head upon contact with the palate or back of the throat. This ensures that the distal end of the curved section always points towards the trachea so that air from the jet channel can be directed specifically to the trachea. The elasticity of the curved section can even increase depending on body temperature. The elasticity of the curved section can also increase gradually or in stages. On the one hand, the elasticity can increase due to the shape, i.e. the curved section is less flexurally rigid towards its distal end, e.g. narrower.It is also conceivable that there is a material-related gradient, so that the material at the distal end behaves more compliantly than at the proximal end of the arc section, with the same geometry and at the same temperature.

[0020] The bite block assembly according to the invention is particularly advantageous when using semi-rigid or rigid endoscopes or catheters, which would inevitably collide with the back of the throat and, in the worst case, could lead to perforation. Sliding against a plastic tongue, such as that formed by a palatal bar of the arch section, reliably prevents such injuries.

[0021] The invention will be explained in more detail below using an exemplary embodiment illustrated in the drawings. They show:

[0022] Figure 1 shows a bite block arrangement for an endoscopy procedure on a model of the oral cavity;

[0023] Figure 2 shows the bite block arrangement of Figure 2 on an anatomical model;

[0024] Figure 3 shows a bite block in a frontal view;

[0025] Figure 4 shows an insert of the bite block arrangement in a side view;

[0026] Figure 5 shows the insert of Figure 4 in a view from below;

[0027] Figure 6 shows the use of figures 4 and 5 in three different perspectives;

[0028] Figure 7 shows a further embodiment of an insert in a perspective view;

[0029] Figure 8 shows the insert of Figure 8 in a side view;

[0030] Figure 9 shows a further embodiment of an insert;

[0031] Figure 10 shows another embodiment of an insert and

[0032] Figure 11 shows another embodiment of an insert and

[0033] Figure 12 shows another embodiment of an insert.

[0034] Figures 1 and 2 show, with the aid of a plastic anatomical model, a bite block assembly 1 comprising a bite block 2 and an elongated insert 3. The bite block 2 is located in a model 4 of the oropharynx.

[0035] The bite block 2 has a front side 6 facing away from the oral cavity 5 of the patient or the model 4, a rear side 7 opposite the front side 6 as well as upper and lower biting surfaces 8, 9 and a bite block opening 10 extending from the front side 5 to the rear side 7, which serves to receive an endoscope 11 (Figure 2) or the insert 3.

[0036] The elongated insert 3 has a proximal end 12 with an insert head 13. The insert head 13 is designed to be clamped into the bite block opening 10. The insert head 13 has an outer contour corresponding to the bite block opening 10 (Figure 3). Figure 3 shows that the bite block opening 10 is essentially rectangular, but has curved constrictions in its lateral regions, i.e., towards the corners of the mouth, so that the cross-section of the bite block opening 10 can be described as cushion-shaped. This prevents accidental incorrect insertion. The bite block 2 has six lateral fastening tabs 14, 15 on its front side for securing the bite block 2 via straps. The bite block 2 further has at least one nozzle-shaped connection 15, 16, either in the lateral corner area or on its front side 6. The connections 15, 16 serve for the passage of gases or as measuring connections.Channels are formed in the bite block 2 in a manner not shown in detail, which open laterally into the bite block opening 10. These internal channels are used to conduct ventilation gases, for example, into adapters that are inserted into the bite block 2.

[0037] The elongated insert 3 has, in addition to the insert head 13, which fits into the bite block opening 10, an atraumatically rounded curved section 17 adjoining the insert head 13. Atraumatic in this context means that the curved section 17 is rounded in such a way that it protects the palate or pharynx and has no sharp edges. Figure 2 shows the use on model 4. In Figure 1, an area 19 can be seen on the posterior pharyngeal wall 18 that should not be injured or even punctured during endoscopy. The curved section 17 protects the posterior pharyngeal wall from injury when the endoscope 11 is inserted by deflecting the flexible endoscope 11 (Figure 2). The special feature of the bite block arrangement according to the invention is that the insert 3 can still be inserted into the bite block opening 10 even when the endoscope 11 is already in the bite block opening 10.The elongated insert is not designed as a tube. The curved section 17 has a palatal ridge 20 along its length from the proximal to the distal end to protect the palate and the posterior pharyngeal wall 18. Furthermore, it has a jet channel 22 for breathing air buccal to the palatal ridge 20, extending from the insert head 13 to the distal end 21 (Figure 5). Furthermore, the insert head 13 has a central longitudinal channel 23, which is open toward an edge 24 of the insert head 13 (Figure 5). The longitudinal channel 23 serves to accommodate the endoscope 11 and other instruments to be inserted into the oral cavity 5. The longitudinal channel in the insert head 13 is not closed around its circumference, but rather is open toward the edge 24 of the insert head 13. In the embodiment of Figures 1 to 6, the open edge side 24 is located opposite the palatal bridge 20.In the embodiment of Figure 5, a slot 25 in the insert head 13, connected to the longitudinal channel 23, is located on the edge 24 opposite the palatal bar 20. Relative to the patient's position, this is the mandibular side of the insert head 13. The slot 25 extends obliquely to the longitudinal direction of the curved insert 3 at its lower end in the image plane. The width of the slot 25 is selected such that an endoscope 11 can be inserted through this slot 25 into the longitudinal channel 23. This can be done outside the body or model 4. Subsequently, the distal end 21 of the elongated insert 3 can be inserted into the bite block opening 10. The oblique course 25 of the slot 25 prevents the endoscope 11 from slipping out of the longitudinal channel 23. Figures 4 and 5 show that a nozzle-shaped connection 26 is arranged on the insert head 13.The lateral connection 26 is connected via internal channels to the two parallel jet channels 22, which carry air for jet ventilation to the distal end 21 of the curved section 17.

[0038] From the illustration in Figure 5, it is clear that the insert head 13 has a head region 27 with a larger cross-section, in which the slot 25 is located. This larger head region 27 adjoins a head region 28 with a smaller diameter. The smaller head region 28 has an outer contour that is adapted to the inner contour of the bite block opening 10. In particular, the narrower head region 28 has lateral concave constrictions that are adapted to the convex constrictions in the bite block opening 10. The larger head region 27 limits the insertion depth of the elongated insert 3 by coming into contact with the front side 6 of the bite block 2 (Figures 1 and 2).

[0039] The embodiment of Figures 1 to 6 further shows that buccal cheek elements 29, 30, which serve as tongue retractors, are formed on the arch section 17. These buccal cheek elements 29, 30 are web-shaped and extend at a distance from the palatal bar 20. Thus, they define a working channel 31 between them, through which, for example, the endoscope 11 shown in Figure 2 is guided.

[0040] The buccal cheek elements 29, 30 can also fulfil the function of the tongue depressor if there are openings 32, 33 in the sides of the cheek elements 29, 30. The openings 32, 33 extend almost over the entire length of the cheek elements 29, 30, which in this case

[0041] In this exemplary embodiment, they are designed only as narrow webs and run essentially parallel to the upper palatal web 20. The distal and proximal ends of the web-shaped cheek elements 29, 30 are arranged on the one hand on the insert head 13, specifically on the narrower head region 28, and are supported distally by an angled portion arranged adjacent to the distal end on the underside of the palatal web 20. In this exemplary embodiment, the angled ends of the web-shaped cheek elements 29, 30 run in the direction of the jet channels 22 arranged to the sides of the palatal web 20. The arch section therefore has a substantially U-shaped cross-section in the length region of the cheek elements 28, 29, which is open mandibularly and is also predominantly open buccally through the openings 32, 33. It is therefore very lightweight and requires only a minimal amount of material to manufacture. In addition, it has limited flexibility and is therefore adaptable.At the same time, the support of the buccal cheek elements 29 on the palatal bar 20 and the jet channels 22 creates a stable connection, allowing the tongue retractor to function reliably even with minimal material input. The curved section 17, which has a U-shaped cross-section, has a working channel 31 that is sufficiently large to accommodate all the elements required for endoscopy.

[0042] Oxygen channels are also integrated into the bite block. They serve to maximize oxygen enrichment by radiating toward the larynx. However, the resulting pressure is not sufficient to periodically fill (ventilate) the lungs. This requires targeted blowing through the glottis, building up a ventilation pressure in the range of more than 10 mbar.

[0043] It is particularly important to note that respiratory support or ventilation of the patient can be provided via the integrated jet channels, with the distal opening of the jet channels 22 always directed towards the glottis or the trachea.

[0044] Depending on the application, i.e., depending on the endoscopy procedure, it may be necessary to use inserts 3 of different lengths or shapes. Therefore, the bite block arrangement according to the invention preferably comprises a set of inserts 3 that have a different shape, so that it is always ensured that the distal end of the jet channels 22 is directed toward the trachea or the glottis. Figures 7 to 11 show various exemplary embodiments, with the previously introduced reference numerals continuing to be used uniformly for components with essentially the same function.

[0045] Figure 7 shows a bite block assembly 1 with a bite block 2, as described above, in combination with an elongated insert 3. The elongated insert 3 is mounted in the bite block 2. It has a curved section 17 with lateral jet channels 22. Figure 8 shows the insert of Figure 7 again in a side view. The insert 3 has an insert head 13 with the previously described mandibularly arranged slot 25 in the insert head 13. In contrast to the embodiment of Figures 1 to 6, however, no buccal cheek elements 29, 30 are present.

[0046] The embodiment of Figure 9 also does not provide for any buccal cheek elements, but in addition to the embodiment of Figures 7 and 8, the insert 3 has a tongue depressor 34. In this embodiment, the tongue depressor 34 is designed in two parts, so that an endoscope 11 can still be inserted into the working channel 31 via the mandibularly arranged slot 25 in the insert head 13 before the elongated insert is inserted into the bite block 2. If the tongue depressor 34 forms a closed surface, similar to the palatal bar 20, the slot 25 would have to be arranged buccally, which is also possible within the scope of the invention.

[0047] The embodiments of Figures 10 and 11 correspond essentially to those of Figures 1 to 6. The difference, however, is that in the embodiment of Figure 10, the elongated insert 3 has a distal end 21 that is arranged at a slightly different angle than the distal end 21 in the embodiment of Figure 11. The difference may be due to the fact that the insert 3 according to Figure 10 is used for bronchoscopy, whereas the insert of Figure 3 is used for gastroscopy. In any case, the use of a suitable insert 3 should ensure that, in combination with a uniform bite block 2, two different endoscopy procedures can be carried out and that sufficient airflow or oxygen can always be precisely directed onto the glottis.

[0048] The illustrated components are preferably made of plastic and are intended for single use. The material composition can change gradually, continuously, or discontinuously along the length of the arched section 17. In particular, it is intended that the arched section 17 be in close contact with the patient's body, i.e., with the palate, so that body heat is transferred to the bite block assembly. The body heat can contribute to increasing the elasticity of the arched section 17, thereby facilitating adaptation to the patient's anatomy, so that the medical examination or treatment can be carried out even more gently.

[0049] The embodiment of Figure 12 shows an elongated insert 3 which, with regard to the design of the tongue depressor, is similar to that of Figure 9. The distal ends of the tongue depressor are not connected to the palate protector. The tongue depressor 34 also serves as a suction outlet for liquids. In each of the rod-shaped cheek elements 29, 30 projecting from the insert head 13, there is a suction channel 35, 36. The two suction channels 35, 36 extend in the longitudinal direction of the cheek elements 29, 30 and are open distally. Proximally, i.e. in the insert head 13, the two suction channels 35, 36 are connected to one another via a connecting channel.

[0050] 37. The connecting channel 37 is connected to a suction nozzle

[0051] 38 for connection to an extraction system.

[0052] The distal end of the palatal protector, i.e., the curved section 17, is designed to convey oxygen or respiratory air toward the trachea, although there is a risk of fluids from the oral cavity being entrained. To prevent fluids from being transported into the lungs, the tongue-side suction described above can be provided.

[0053] Reference symbol:

[0054] 1- Bite block arrangement

[0055] 2- Bite block

[0056] 3- elongated insert

[0057] 4- Model

[0058] 5- Oral cavity

[0059] 6- Front of 2

[0060] 7- Back of 2

[0061] 8- upper biting surface of 2

[0062] 9- underside biting surface of 2

[0063] 10- Bite block opening in 2

[0064] 11- Endoscope

[0065] 12- Proximal end of 3

[0066] 13- Insert head of 3

[0067] 14- Mounting hole

[0068] 15- Connection to 13

[0069] 16- Connection to 13

[0070] 17- Arch section

[0071] 18- Posterior pharyngeal wall

[0072] 19- Area in 18

[0073] 20- Palatal Bridge 21

[0074] 21- distal end of 3

[0075] 22- Jet channel of 3

[0076] 23- Longitudinal channel in 3

[0077] 24- margin page of 13

[0078] 25- Slot in 24

[0079] 26- Connection of 13

[0080] 27- larger head area of ​​13

[0081] 28- narrower head area of ​​13

[0082] 29- Cheek element

[0083] 30- Cheek element

[0084] 31- Working channel - buccal opening- buccal opening- tongue depressor- suction channel - suction channel - connecting channel- suction nozzle

Claims

Patent claims 1 . Bite block arrangement (1 ) for endoscopy procedures with the following features: a) A bite block (2) has a front side (6) facing away from the oral cavity (5) of a patient, a rear side (7) facing the oral cavity (5) and upper and lower biting surfaces (8, 9), wherein a bite block opening (10) extends from the front side (6) to the rear side (7) through the bite block (2), which opening is designed to receive an elongated insert (3); b) The elongated insert (3) has an insert head (13) at its proximal end (12) which can be inserted into the bite block opening (10) in a clamping manner, and an atraumatically rounded curved section (17) adjoining the insert head (13) for protecting the palate, wherein the rounded curved section (17) has a distal end ( ) oriented towards the trachea;c) The arch section (17) has a palatal ridge (20) along its length to protect the palate and the posterior pharyngeal wall (18), and it has at least one jet channel (22) for breathing buccal to the palatal ridge (20), extending from the insert head (13) to the distal end (21); d) The insert head (13) has a central longitudinal channel (23), the longitudinal channel (23) being open to an edge side (24) of the insert head (13); 2. Bite block arrangement (1) according to claim 1, characterized in that the insert head (13) has a connection (26) for jet ventilation via the at least one jet channel (22).

3. Bite block arrangement (1) according to claim 1 or 2, comprising a plurality of inserts (3) with a different geometry or size.

4. Bite block arrangement (1) according to one of claims 1 to 3, characterized in that the curved section (17) buccal cheek elements (29, 30) so that it is U-shaped in cross-section and mandibularly open.

5. Bite block arrangement (1) according to claim 4, characterized in that the buccal cheek elements (29, 30) are designed as web-shaped tongue hold-down devices, wherein the cheek elements (29, 29) and the palatal bar (20) delimit a working channel (31) between them.

6. Bite block arrangement (1) according to claim 4 or 5, characterized in that the cheek elements (29, 30) have buccal openings (32, 33).

7. Bite block arrangement (1) according to one of claims 1 to 6, characterized in that a slot (25) connected to the longitudinal channel (23) is arranged mandibularly or buccally in the insert head (13).

8. Bite block arrangement (1) according to one of claims 1 to 7, characterized in that a lingual bar as a tongue hold-down device (34) is arranged on the insert head (3) at a distance from the palatal bar (10).

9. Bite block arrangement (1) according to claim 8, characterized in that the slot in the insert head (3) is arranged buccally.

10. Bite block arrangement (1) according to one of claims 1 to 9, characterized in that the curved section (17) has an elasticity which is so great that, when used as intended, the curved section (17) is bent relative to the insert head (3) upon contact with the palate or the back wall of the throat (18).

11. Bite block arrangement (1) according to one of claims 1 to 10, characterized in that the elasticity of the curved section (17) increases towards the distal end (21) due to the material and / or shape.

12. Bite block arrangement (1) according to one of claims 4 to 11, characterized in that a suction channel (35, 36) is arranged in at least one of the cheek elements (29, 30).

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