the present nasal ventilation system 10 is shown in fig1 as comprising ventilation tube 20 and elongated introducer 30 , suitable for creating an amo within lateral nasal wall 70 ( shown with the middle turbinate and uncinate removed to allow visualization of the natural ostium ), proximate maxillary ostium 71 , maxillary fontanelle 72 , and inferior turbinate 73 . a distal tip of introducer 30 is insertable through a central channel of ventilation tube 20 , is releasably attachable to ventilation tube 20 , and includes a sharp , removable cutting obturator at the distal tip . as shown in fig1 and 3 , in operation , introducer 30 with ventilation tube 20 at its distal end are introduced into the middle meatus in the region of the fontanelle ( anterior or posterior ) under endoscopic assistance , facilitated by the obturator 100 . referring to fig3 , obturator 100 includes proximal flexible shaft 101 and sharp distal cutting tip 102 . once the membraneous fontanelle or other targeted area is identified , obturator 100 is advanced through introducer 30 and ventilation tube 20 until cutting tip 102 extends beyond ventilation tube 20 , and cutting tip 102 and ventilation tube 20 are pushed through the fontanelle . obturator 100 and introducer 30 are then removed . an endoscope is preferably employed to provide visualization during this procedure . ventilation tube 20 and introducer 30 are shown in further detail in fig2 a . ventilation tube 20 include grommet - like member or proximal flange 21 , retaining member or distal flange 22 , and channel 23 extending through ventilation tube 20 , terminating in opposing apertures extending through grommet - like member 21 , retaining member 22 of ventilation tube 20 . as shown in fig2 a , upon placement of ventilation tube 20 , grommet - like member 21 and conical or frusto - conical retaining member 22 are disposed on opposing sides of the amo extending through lateral nasal wall 70 , and serve to maintain ventilation tube 20 in place . as indicated by the phantom lines of fig2 a , introducer 30 is preferably constructed of a relatively flexible material to permit the introducer 30 to be readily advanced through the paranasal sinus passages to the desired site of the amo . ventilation tube 20 may be constructed of a variety of plastic - like materials commonly used in medical devices , including materials commonly employed in middle ear ventilation tubes . moreover , ventilation tube 20 may be constructed of a drug eluting material , and may include compounds such as steroids or minerals / elements to decrease viral contamination , inflammatory reactions , and bacterial colonization . furthermore , ventilation tube 20 may be constructed of a resorbable material , similar to those used in bio - absorbable sutures , and capable of dissolving in situ over time . an alternative construction of the ventilation tube , namely ventilation tube 20 ′, is shown in fig2 b . in this alternative embodiment , the retaining member comprises expandable feet 22 ′ serving , in cooperation with grommet - like member 21 , to retain ventilation tube 20 in place though the membranous fontanelle . as shown in fig4 , once ventilation tube 20 is placed and seated through lateral nasal wall 70 proximate frontal sinus 75 , ehtnoid sinus 76 , sphenoid sinus 78 and eustachian tube 78 , introducer 30 and its associated obturator are separated from ventilation tube 20 and removed . next , as shown in fig5 , irrigation catheter 40 may be placed , by inserting distal tip 41 of irrigation catheter 40 into , or entirely through , channel 23 of ventilation tube 20 . irrigation fluid 80 may then be injected into irrigation catheter 40 and thus introduced into the desired treatment area to flush the contents of the sinus cavity . the contents of the sinus cavity can then be pushed through the principal or main maxillary ostium to un - block the natural ostium . as indicated by the phantom lines of fig5 , irrigation catheter 40 is preferably constructed of a relatively flexible material to permit distal tip 41 of irrigation catheter to be advanced into the paranasal sinuses and placed through ventilation tube 20 . as shown in fig6 , a separate , smaller diameter secondary irrigation catheter 50 may be used in conjunction with irrigation catheter 40 . distal tip 51 of secondary catheter 50 is inserted through an opening at proximal end 42 of irrigation catheter 40 , and is advanced beyond distal tip 41 of irrigation catheter 40 and into the targeted sinus cavity . irrigation fluid 80 is then injected into secondary irrigation catheter 50 and is thus introduced to the desired treatment area to flush the contents of the sinus cavity . moreover , and as shown in fig7 , distal tip 51 of secondary catheter 50 may be inserted more deeply into the targeted sinus cavity to deeply instill liquids within the antrum , by further advancing secondary catheter 50 through irrigation catheter 40 . alternatively , and as shown in fig8 , balloon catheter 60 may be employed in place of secondary irrigation catheter 50 . balloon catheter 60 includes distal tip 61 , and expansile member 62 surrounding a distal portion of the main lumen of the balloon catheter 60 . as shown in fig8 , distal tip 61 may be placed through irrigation catheter 40 and advanced deeply into the targeted sinus cavity . expansile member 62 is then inflated . this , in turn , causes the contents of the sinus cavity , such as mucous or purulent debris 90 , to be expressed through the natural pmo 71 . as shown in fig9 , distal tip 61 of balloon catheter 60 may alternative or additionally be advanced through irrigation catheter 40 and the sinus cavity to extend through the natural pmo 71 . next , as shown in fig1 , expansile member 62 is inflated , in order to dilate the natural pmo 71 . fig1 is a view of another embodiment of an elongated introducer 100 . the introducer 100 includes a proximal end 102 and a distal end 104 . a tube or shaft 106 extends between the proximal end 102 and distal end 104 . a rod 108 extends within the tube 106 . the rod 108 includes a proximal end 110 extending out of tube 106 and a distal end ( not shown ) located at the distal end 104 of the introducer 100 . an obturator 112 is located at the distal end 104 . in one embodiment , the obturator 112 is secured to the distal end of the rod 108 . fig1 is a view of the elongated introducer 100 taken along line 12 - 12 of fig1 . fig1 shows the obturator 112 includes a shaft 114 , a flange 116 and a sharp , distal cutting tip 118 . the shaft 114 may be cylindrical or conical shaped , for example . the elongated introducer 100 may be coupled to a myringotomy apparatus or handle ( not shown ), such as will be understood in the art . such an apparatus typically includes a mechanism to secure the tube 106 in a stationary manner with respect to the apparatus . the rod 108 may be coupled to a trigger mechanism for slidingly activating and controlling the rod 108 with respect to the tube 106 . thus , activation of the trigger of the apparatus controls movement of the obturator 112 . the tube 106 of the introducer 100 may be made of a flexible or malleable material to permit the introducer 100 to be readily advanced through the paranasal sinus passages to the desired site of the amo . fig1 a shows another embodiment of the ventilation tube 130 . the ventilation tube 130 includes the conical or frusto - conical retaining member 132 , a shoulder 134 , grommet - like member 136 having flat side edges 138 , and a central channel or bore 140 extending through the ventilation tube 130 . as understood from the above description , the obturator 112 receives the ventilation tube 130 . in particular , the shaft 114 is designed to be received by the central channel 140 . the shaft 114 and channel 140 may be designed to provide a releasable locking engagement , such as an interference press fit or a snap - fit engagement . the shaft 114 may be cylindrical or conical , for example , with the central channel 140 similarly shaped for a mating engagement . with the obturator 112 inserted into the ventilation tube 130 , the flange 116 and grommet - like member 136 limit the depth in which the obturator 11 is inserted within the central channel 140 . with the flange 116 engaging the grommet - like member 136 , the sharp distal cutting tip 118 projects beyond the conical retaining member 132 . thus , the combined introducer 100 and ventilation tube 130 are adaptable for piercing the tissue and forcing the ventilation tube 130 in place , with the shoulder on one side of the wall and the grommet - like member on the other side of the wall . in another embodiment , the ventilation tube may take other forms such as omitting the distal flange . in fig1 b , another embodiment of the ventilation tube is shown . in particular , ventilation tube 170 shows a neck portion or sleeve 172 having a proximal end 174 with a proximal flange 176 . as an example , the flange may be tab shaped as shown in fig1 b or annular shaped . the distal end 178 includes a beveled edge 180 which provides a sharp cutting tip 182 . the ventilation tube 170 shown in fig1 b is more readily inserted by use of forceps ( not shown ). for example , the forceps may grip the proximal flange or tab 176 . the forceps will be used to guide the tube in place , urging the sharp cutting tip 182 through the sinus wall , and wherein the tab will also limit the insertion depth of the ventilation tube . it will be appreciated that an obturator is not required for inserting the tube 170 into the wall . in addition , it will be appreciated that the forceps may be used instead of the introducer described above . however , when the term “ introducer ” is used herein , it is intended to include forceps . fig1 shows another embodiment of a catheter used utilized for delivering a pharmaceutical drug , fluid or the like to the sinus cavity . the catheter 150 is a graphical representation . the catheter 150 includes a hollow shaft 152 . the shaft 152 may be of a malleable material or flexible material to permit the catheter to be readily advanced through the sinus passages to the desired site of the amo , and in particular to the location of the ventilation tube . it will be appreciated that the shaft 152 will be proportionally longer than that shown in fig1 . the distal end 154 of the catheter 150 includes an irrigation tip 156 . the irrigation tip 156 may be generally conical in shape . the conical shape more readily accommodates insertion of the tip 156 into the ventilation tube 130 . the irrigation tip 156 may be hollow to provide for fluid and drug flow from the shaft . the irrigation tip 156 may include a delivery opening 158 at the distal end 154 . in addition , the wall of the irrigation tip 156 may include micro pore perforations 160 . the delivery openings 158 and micro pore perforations 160 provide delivery of the drug or fluid . a flange 162 is provided to limit the insertion depth of the catheter 150 . the flange 162 will engage the grommet - like member to limit the insertion of the catheter . it will be appreciated that the ventilation tube of the present invention may be used to deliver topical fluids , drugs , anti - inflammatory medications , such as steroids , gene treatments , etc ., drug delivery substances , and drug impregnated coils , and beads through simple insertion or via powered pulsation . for example , a device for delivering such items , such as the catheter 150 for example , may be guided toward the inserted ventilation tube , whereupon the desired item may be delivered directly to the sinus , or in a manner consistent with the description herein . in one embodiment , the delivery device may be adapted for insertion into the first catheter , to assist in guiding the delivery device to the ventilation tube .
an apparatus for creating an accessory maxillary ostium for purposes of ventilation , irrigation , or procedural work within the maxillary antrum . an introducer having a ventilation tube and grommet is provided to create and then provide access through the accessory maxillary ostium . an irrigation catheter may be advanced through the ventilation tube in order to irrigate or express the contents of the sinus cavities . a secondary irrigation catheter or a balloon catheter may be advanced through an outer irrigation catheter , deeply into the sinus cavity , in order to irrigate or express the contents of the sinus cavities . moreover , the balloon catheter may alternatively or additionally be employed to for dilation of the natural ostium . still further , a device for delivering drugs , fluids or the like , may be coupled to the ventilation tube for delivery of same .