=Paper=
{{Paper
|id=Vol-2753/paper30
|storemode=property
|title=Solutions to the 3D Model Problem of Pressure Measurement in the Area of Maxillary Sinus Anastomosis
|pdfUrl=https://ceur-ws.org/Vol-2753/paper20.pdf
|volume=Vol-2753
|authors=Alina Nechyporenko,Viktor Reshetnik,Denys Shyian,Victoriia Alekseeva,Radiy Radutny,Vitaliy Gargin
|dblpUrl=https://dblp.org/rec/conf/iddm/NechyporenkoRSA20
}}
==Solutions to the 3D Model Problem of Pressure Measurement in the Area of Maxillary Sinus Anastomosis==
https://ceur-ws.org/Vol-2753/paper20.pdf
Solutions to the 3D Model Problem of Pressure Measurement
in the Area of Maxillary Sinus Anastomosis
Alina Nechyporenkoa,b, Viktor Reshetnikb, Denys Shyianc, Victoriia Alekseeva c, Radiy
Radutnyd and Vitaliy Garginc
a
Technical University of Applied Sciences University Technische Hochschule Wildau Hochschulring 1, Wildau
115745 Germany
b
Kharkiv National University of Radio Electronics, 14 Nauky Ave., Kharkiv, 61166, Ukraine
c
Kharkiv National Medical University, 4 Nauky Ave., Kharkiv, 61022, Ukraine
d
National Aviation University 1 Liubomyra Huzara Ave., Kyiv 03058, Ukraine
Abstract
The ostiomeatal complex (OMC) is a key area that determines the occurrence of
inflammatory processes in the paranasal sinuses (PNSs). The aim of our work was to develop
a procedure for studying the OMC components in the preoperative period that allows for
identification the impact of anatomical peculiarities on change of physiological pressure in
the maxillary sinus. Materials and methods: The study was carried out on the basis of the
otorhinolaryngological department of Kharkiv Regional Clinical Hospital in 2019-2020. It
involved 100 patients of both sexes aged 20-59 years with chronic non-polyposis maxillary
sinusitis. Results: The sizes of the uncinate process, the middle turbinate and the natural
anastomosis were determined using the calculation of uncertainty. Basing on the data
obtained, all the patients were divided into three groups. Conclusions: Changes in the size
of the natural anastomosis (both an increase and its narrowing) lead to changes in pressure in
the area of the anastomosis, and a decrease in ventilation in the paranasal sinuses. SCT study
with subsequent 3D modeling is an informative, accurate and effective method for
assessment of OMC and PNSs condition. It allows surgeons to presume the method and
volume of surgery as early as at the preoperative stage, without resorting to invasive research
methods.
Keywords 1
Ostiomeatal comlex, pressure, 3D Model
1. Introduction
The ostiomeatal complex (OMC) is a key area that determines the possibility of inflammatory
processes in the paranasal sinuses (PNSs) [1, 2]. The anatomical features of this area determine
aerodynamic disturbances, decreased ventilation of the sinuses and, consequently, stagnation with
subsequent involvement of bacterial, fungal or mixed microflora [3, 4]. Since the OMC components
are difficult to access for examination, the main method for assessing their condition is spiral
computed tomography (SCT) [5, 6]. Taking into account the variety of options for the location of the
OMC components, the complexity of their spatial configuration, use SCT images without further
construction of a 3D model can lead to diagnostic errors due to the assessment of objects located in
the same plane [7, 8]. It was defined that 3D modeling with the construction of a 3D model of the
specified anatomical region gives scientists more information. This method can accurately, quickly,
effectively and correctly describe all the variants of the location of the OMC components, namely, the
uncinate process [9, 10].
IDDM’2020: 3rd International Conference on Informatics & Data-Driven Medicine, November 19–21, 2020, Växjö, Sweden
EMAIL: nechyporenko@th-wildau.de (A. Nechyporenko); viktor.reshetnik@nure.ua (V. Reshetnik); den.sheyan@gmail.com (D. Shyian);
vik13052130@i.ua (V. Alekseeva); radiy@yahoo.com (R. Radutny); vitgarg@ukr.net (V. Gargin). Month October, 2020, Kharkiv, Ukraine
ORCID: 0000-0002-4501-7426 (A. Nechyporenko); 0000-0002-8021-4310 (V. Reshetnik); 0000-0002-3755-7051 (D. Shyian); 0000-0001-
5272-8704 (V. Alekseeva); 0000-0001-6339-5909 (R. Radutny); 0000-0001-8194-4019 (V. Gargin).
© 2020 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
In addition, there are invasive methods to determine the ventilation efficiency of the PNSs [11,
12]. In particular, one of the methods involves intraoperative placement of a sensor in the area of the
natural anastomosis of the maxillary sinus, which allows surgeons to measure the pressure in this area
and make a conclusion about the risk of developing inflammatory processes [13, 14]. Despite all the
information content and accuracy, this assessment method has some significant drawbacks. Since the
sensor is installed intraoperatively, it is impossible to calculate the indicators characterizing the
efficiency of sinus ventilation in the preoperative period and hence to predict the volume of the
operation. Alternatively, there is a need for additional intervention in order to install the sensor, which
is associated with inconveniences for both the doctor and the patient [15, 16]. The second important
disadvantage is the invasiveness of the procedure.
Nowadays, there are a large number of studies devoted to 3D modeling both by SCT [17], and
MRI [18]. There are even comparative characteristics between the 3D model and SCT images [19] or
3D images and examination with endoscopic surgery [20, 21].
Compared with the others, the current study makes use of approach based on the calculation of
uncertainty. Moreover, the pattern of pressure in the maxillary sinus has been studied by many
researchers. In most cases it was associated with the study of the patency of the maxillary fistula in
determining the indications for surgery or was a criterion for the time course of treatment [10].
Our study involves a unique approach due to calculation of parameters with uncertainty, which
enables to perform all the measurements of OMC components in a more effective way as well as
decrease the amount of errors.
The aim of current work was the development of a procedure for studying the characteristics of
OMC components in the preoperative period that enable to determine the influence of anatomical
peculiarities on alteration of physiological pressure in the maxillary sinus.
2. Materials and Methods
The study was conducted at the otorhinolaryngological department of Kharkiv Regional Clinical
Hospital in 2019-2020. 100 patients of both sexes aged 20-59 years (see Table 1) with chronic non-
polyposis maxillary sinusitis (cyst of the maxillary sinus) participated in the experiment.
Table 1 Distribution of patients under investigation by age and sex
Patient Group Male Female
20-44 19 29
45-59 22 30
Total 41 59
In order to exclude the odontogenic origin of inflammatory process, the patients were consulted by
a maxillofacial surgeon. All patients in the preoperative period underwent a CT scanning. This
implied application of a spiral computed tomograph Toshiba Aquilion 64 CT Scanner, a multi-slice
CT scanner with the ability to simultaneously collect data from 64 slices 0.5 mm thick and featuring
high performance characteristics with a full turnover time of up to 0.4 s.
The data obtained were studied using the RadiAnt DICOM Viewer software. 3D models were built
in the Artec Studio 14 application, which characterized by high accuracy, fast image quality control,
improved color reproduction and automatic glare removal. After examination of the SCTs (see Fig. 1-
3). 3D models of all the examined patients were rendered (see Fig. 4). Attention was paid to such
basic OMC parameters as the middle turbinate, the uncinate process and the size of the natural
anastomosis (see Figure 1). Due to the diversity of the data obtained, some difficulties are presented
by the choice of reference points for measuring the width of the indicated anatomical structures. In
this regard, the same technique which was successfully used in our previous studies to measure both
the OMC structures and the indicators of the length and density of the walls of the PNSs was applied.
[11, 12]. This technique implies calculating the uncertainty of these indicators.
Figure 1: Group 1 patient SCT. Coronary section. OMC
Figure 2: Group 1 patient SCT. Coronary section. OMC
Measurement uncertainty is an internationally recognized feature of measurement inaccuracy [13],
pertaining to the measurement result and identifying the set of values which can be logically assigned
to the measured quantity [14]. All constituents of the uncertainty of the input quantities are classified
into two categories according to the method of their assessment: category A involves constituents that
are assessed using statistical methods (according to the results of multiple measurements), and
category B implies constituents that are evaluated otherwise (in agreement with features stated in the
specification of the measuring instrument, the calibration certificate, the measurement methodology,
the preliminary tests, etc.).
Figure 3: Group 3 patient SCT. Coronary section. OMC
Figure 4: Group 3 patient with 3 D OMC modeling (1 – uncinated process, 2 – middle nasal concha, 3
– anastomosis)
3. Results
The results of calculation using the basic algorithm developed in our previous works [11-12] are
presented in Tables 2-4.
Table 2 OMC components dimensions in the first group of patients
Uncertainty Parameter under study
indicator Uncinated process Middle nasal concha Natural
anastomosis
Max Min Max Min Max Min
UA 0.084 0.079 0.258 0.119 0.065 0.101
UB 0.000003 0.0000012 0.0000039 0.000001 0.0000022 0,0000016
Us 0.0843 0.079 0.2584 0.1195 0.065 0.1008
Uex 0.1687 0.1584 0.5168 0.2389 0.1301 0.2015
Table 3 OMC components dimensions in the second group of patients
Uncertainty Parameter under study
indicator Uncinated process Middle nasal concha Natural
anastomosis
Max Min Max Min Max Min
UA 0.065 0.121 0.089 0.099 0.117 0.090
UB 0.0000021 0.0000012 0.0000023 0,0000013 0,0000034 0,0000027
Us 0.065 0.1212 0.0891 0.0991 0.1170 0.0904
Uex 0.13 0.2424 0.1781 0.1982 0.2339 0.1809
Table 4 OMC components dimensions in the third group of patients
Uncertainty Parameter under study
indicator Uncinated process Middle nasal concha Natural
anastomosis
Max Min Max Min Max Min
UA 0.055 0.126 0.075 0.121 0.058 0.132
UB 0.0000026 0.0000013 0.0000028 0.0000016 0.0000029 0.0000020
Us 0.0549 0.1264 0.0747 0.1211 0.0577 0.1320
Uex 0.1098 0.2528 0.1494 0.2423 0.1153 0.2641
After a preliminary investigation of the SCT, patients were recommended to undergo surgical
treatment in the volume of endoscopic removal of the maxillary sinus cyst, during which the pressure
in the maxillary sinus area was measured
Pressure measurements were carried out using the developed hardware-software system “Imed”.
Functionally, the hardware-software system consists of a measuring and software modules. It is
shown in Fig. 5.
Differential pressure measurement range ± 7000 Pa, displayed range ± 1200 Pa, sampling
frequency of measuring channels scanning 200 Hz, bandwidth 1 kHz, limits of permissible reduced
error when measuring pressure do not exceed ± 0.25%, supply voltage 5 V, power consumption less 2
W, protection class IP20. The measured values during the study are the air flow pressure in the
maxillary sinus and nasopharynx. The measured signals are recorded synchronously. The block
diagram of the measuring module is shown in Fig. 6. Graphs of the average pressure are presented in
Fig. 7-9.
Figure 5: Measuring module of the hardware-software complex “Imed”
Figure 6: Block diagram of the measuring module of the hardware-software complex “Imed”
Figure 7: Graph of the average pressure in the anastomosis in Group 1 patients
Figure 8: Graph of the average pressure in the anastomosis in Group 2 patients
Figure 9: Graph of the average pressure in the anastomosis in Group 3 patients
Morphometry is crucial for obtaining correct data in contemporary medicine [15] with adequate
mathematical support [16]. It could be used for the description of morphological images [17] with
compound simulation [18,19] in paranasal area [20,21].
Thus, the data obtained in the experiment allow us, as early as at the preoperative stage, to assume
the features of sinus ventilation of every patient without additional examination. It means that the
volume of the surgery and possible postoperative risks can be determined in advance. [22].
Until recently, the pressure indicator in the maxillary sinus has been taken into account mainly
during implantation [23, 24] due to the employment of hydraulic pressure for these purposes.
This study for the first time has involved a simultaneous estimation of the pressure in the maxillary
sinus and the anatomical structure of the OMC, caused by it. A group of patients (Group 3) has been
found to have “critical” indicators of the size of the middle turbinate, the uncinate process and the
natural anastomosis with decreased pressure in the sinus, entailing hypoventilation with the possible
development of an inflammatory process.
In addition, it should be noted that the pressure indicator is very sensitive to the size of the
anastomosis. Even a slight expansion or narrowing of the natural communication between the sinus
and the nasal cavity leads to changes in pressure in the sinus. This fact should be taken into account
during surgical interventions.
An interesting fact is that the large anastomosis also does not provide adequate ventilation of the
sinus. Most likely, this can be explained by the absence of a turbulent air flow in the sinus, which also
leads to its hypoventilation and increases the risk of bacterial or fungal microflora attachment.
Moreover, for the first time, 3D modeling has been used to calculate the values of indicators,
which most accurately reflect not only the main parameters of the structure, but also the entire
complexity of their spatial configuration. In addition, the creation of a 3D model will be useful for
training medical personnel. They will be able to perform surgical interventions with different variants
of the structure of the BMC as well as various manipulations on its components (resections, plastic,
reconstructive operations on the uncinate process, middle turbinate). Further perspectives of current
study are the development of multifunctional and user-friendly system for image assessment [25], as
well as augmentation model for training [26] and web-application for decision-making in ENT
surgery [27].
Thus, the research supplemented and combined our previous studies and new data which were
obtained [28, 29,30] with processing in patients of different age and gender [31].
4. Conclusion
Alterations in dimensions of the natural anastomosis (both an increase and its narrowing) lead to
oscillations in pressure in the area of the anastomosis, and decrease in ventilation in the paranasal sinuses.
It is recommended to integrate the SCT study based on 3D modeling to a medical practice as an
informative, accurate and effective method for assessment of OMC and PNSs condition. It will enable
medical doctors to optimize the surgical planning and avoid the invasive examination.
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