ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 32 of 50
Up
УЖМБС 2021, 6(3): 238–249
https://doi.org/10.26693/jmbs06.03.238
Modeling in medicine

Support System of Doctor’s Decision-Making on the Choice of a Method for Treating Fractures of the Midface Area

Khudyk A. K. 1, Kochina M. L. 2, Firsov O. G. 3
Abstract

The purpose of the study is to develop a support system of doctor’s decision-making on the choice of a method for treating fractures of the midface are. Materials and methods. The study includes the results of examination and treatment of 112 patients with fractures of the midface area, who were undergoing inpatient treatment in the Department of Head and Neck Surgery of the Municipal Noncommercial Enterprise of Kharkiv Regional Council «Regional Clinical Hospital», Kharkiv. All patients at hospitalization underwent examination according to the local protocol. The diagnosis was based on the results of cone-beam computed tomography, or multislice computed tomography. To determine the initial condition, as well as to assess the functional and cosmetic effects in the treatment process (1st, 3rd, 5th and 7th days) a visual analogue scale was used, at hospitalization we also used a visual analogue scale modified by us, which contains a point evaluation of the patient's condition for 12 signs of trauma. The Scilab computer algebra system was used to develop models for predicting the results of treatment of the midface area fractures using various methods, and a graphical application for the Windows operating system was developed for the practical use of the support system of doctor’s decision-making, in which the Sugeno fuzzy inference machine was integrated into the developed models Results and discussion. To predict the displacement of bone fragments that will remain after the surgery, the following indicators and signs were used: the nature of the fracture, the presence of paraesthesia in the infraorbital area, the presence of hemosinus; method of treatment; indicator by the modified visual analogue scale. To predict the indicator on a visual analogue scale a day after the surgery, the following indicators and signs were used: the nature of the fracture, the presence of paraesthesia in the infraorbital area, the presence of hemosinus; method of treatment, the number of plates in the case of metal osteosynthesis, the indicator by a visual analogue scale before surgery. To predict indicators by a visual analogue scale in the subsequent terms, the values of indicators by this scale in the previous terms are added to the input indicators of the model. Conclusion. As a result of the research it was found that the following can be used as the functional and cosmetic results of treatment of the midface area fracture in the development of predicting models: the amount of displacement of bone fragments, which was determined by computed tomography after surgery, and the values of indicators by a visual analogue scale after a day, 3, 5 and 7 days after surgery. The developed models for predicting functional and cosmetic results of treatment as a result of testing using indicators of 112 patients with fractures of the midface area showed an overall accuracy of 91.6%, sensitivity – 95%, specificity –96.4%.

Keywords: fractures of the midface area, methods of treatment, predicting models, fuzzy logic, support system of doctor’s decision-making

Full text: PDF (Ukr) 892K

References
  1. Ahmed DR, Dhasarathan PR, Muthusekhar D. Incidence and etiology of midface fracture: a retrospective study. Annals of Tropical Medicine and Health. 2020 Nov; 23: 232-315. https://doi.org/10.36295/ASRO.2020.232315
  2. Dağaşan VÇ. Diagnosis and management of midfacial fractures. Part II. Academic Studies in Health Sciences; 2020. 155 p.
  3. Schneider M, Besmens IS, Luo Y, Giovanoli P, Lindenblatt N. Surgical management of isolated orbital floor and zygomaticomaxillary complex fractures with focus on surgical approaches and complications. Journal of Plastic Surgery and Hand Surgery. 2020 Jul 31; 54(4): 200-6. PMid: 32493085. https://doi.org/10.1080/2000656X.2020.1746664
  4. Juncar M, Tent PA, Juncar RI, Harangus A, Mircea R. An epidemiological analysis of maxillofacial fractures: a 10-year cross-sectional cohort retrospective study of 1007 patients. BMC Oral Health. 2021 Mar; 21(1): 128. PMid: 33731083. PMCid: PMC7968332. https://doi.org/10.1186/s12903-021-01503-5
  5. Xavier SA, Wahab A, Sivakumar M. Prevalence of Midface Fractures-A Retrospective Institution Based study. Journal of Contemporary Issues in Business and Government. 2021 Feb 18; 27(2): 595-9. https://doi.org/10.47750/cibg.2021.27.02.073
  6. Sinha V, Chaudhary N, Jha SG, Chaudhari NP. Management of Maxillofacial Trauma in Road Traffic Accident (RTA) at Tertiary Care Center. Indian Journal of Otolaryngology and Head & Neck Surgery. 2021 Jan 7; 1-7. https://doi.org/10.1007/s12070-020-02299-6
  7. Hino S, Yamada M, Iijima Y, Araki R, Kaneko T, Horie N. Effects of alcohol consumption on maxillofacial fractures in simple falls. Clinical and experimental dental research. 2020 Oct; 6(5): 544-9. PMid: 32720445. PMCid: PMC7545223. https://doi.org/10.1002/cre2.308
  8. Hirvikangas R, Bertell J, Marttila E, Löfgren M, Snäll J, Uittamo J. Patient injury-related alcohol use-underestimated in patients with facial fractures? Oral surgery, oral medicine, oral pathology and oral radiology. 2020 Sep 1; 130(3): 236-40. PMid: 32499150. https://doi.org/10.1016/j.oooo.2020.03.041
  9. Yuldashev I, Rakhmanov A, Urgunaliev B, Yuldasheva G, Tynaliev U, Kulnazarov A. Frequency of midfacial traumatic injuries-A report from the maxillofacial reconstructive and plastic surgery department of Kyrgyz Republic Health Service Ministry's National Hospital, Bishkek from 2013-17-A retrospective study. Annals of Maxillofacial Surgery. 2020 Jul 1; 10(2): 377. PMid: 33708583. PMCid: PMC7943996. https://doi.org/10.4103/ams.ams_2_20
  10. Kovalenko WW. Osoblivosti likuvannya suchasnih boyovih ushkodzhen schelepno-litsevoyi dilyanki [Features of the treatment of modern combat damage to the maxillofacial region]. Likarsʹka sprava. 2017 Mar 30; 1-2: 168-74. [Ukrainian]
  11. Kaura S, Kaur P, Bahl R, Bansal S, Sangha P. Retrospective study of facial fractures. Annals of maxillofacial surgery. 2018 Jan; 8(1): 78. PMid: 29963429. PMCid: PMC6018280. https://doi.org/10.4103/ams.ams_73_17
  12. Sansgiri T, Prasad K, Kumar V, Ranganath K, Rajanikanth BR, Sejal KM, et al. Comparative Assessment of Microplates with Miniplates in the Fixation of Midface Fractures: A Prospective Study. Journal of Maxillofacial and Oral Surgery. 2020 Oct 1: 1-9. https://doi.org/10.1007/s12663-020-01453-5
  13. Shokri T, Sokoya M, Cohn JE, Bahrami A, Inman J, Ducic Y. Single-Point Fixation for Noncomminuted Zygomaticomaxillary Complex Fractures-A 20-Year Experience. Journal of Oral and Maxillofacial Surgery. 2020 May 1; 78(5): 778-81. PMid: 32006491. https://doi.org/10.1016/j.joms.2019.12.030
  14. Choi JW, Kim MJ. Treatment of panfacial fractures and three-dimensional outcome analysis: the occlusion first approach. Journal of Craniofacial Surgery. 2019 Jun 1; 30(4): 1255-8. PMid: 30946230. https://doi.org/10.1097/SCS.0000000000005528
  15. Hardt N, Sepehrnia A, Kessler P. Anatomy and topography of the craniofacial region. In: Craniofacial Trauma. Cham: Springer; 2019. p. 19-33. https://doi.org/10.1007/978-3-319-77210-3_2
  16. Liu BY, Cao G, Dong Z, Chen W, Xu JK, Guo T. The application of 3D-printed titanium mesh in maxillary tumor patients undergoing total maxillectomy. Journal of Materials Science: Materials in Medicine. 2019 Nov; 30(11): 1-7. PMid: 31728639. https://doi.org/10.1007/s10856-019-6326-7
  17. Raisian S, Fallahi HR, Khiabani KS, Heidarizadeh M, Azdoo S. Customized titanium mesh based on the 3D printed model vs. manual intraoperative bending of titanium mesh for reconstructing of orbital bone fracture: a randomized clinical trial. Reviews on recent clinical trials. 2017 Sep 1; 12(3): 154-8. PMid: 28828975. https://doi.org/10.2174/1574887112666170821165206
  18. Ma J, Ma L, Wang Z, Zhu X, Wang W. The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures: a case report. Medicine. 2017 Jul; 96(27). PMid: 28682875. PMCid: PMC5502148. https://doi.org/10.1097/MD.0000000000007250
  19. Voloshan O, Grigorov S, Demyanyk D. Development and analysis of diagnostic criteria for creation of an automated computer software for predicting the course and individualizing the treatment of patients with odontogenic maxillary sinusitis. Wiad Lek. 2020; 73(4): 767-772. PMID: 32731713
  20. Voloshan OO, Grigorov SM, Demyanyk DS, Ruzin GP, Lokes KP. Prospects of an automated computer software implementation for prediction of course and treatment in patients with different forms of odontogenic maxillary sinusitis. Mir mediciny i biologii. 2019; 15(4 (70)). https://doi.org/10.26724/2079-8334-2019-4-70-39-45
  21. Bashiri S, Malekzadeh H, Fekrazad R. The effect of delayed photobiomodulation on neurosensory disturbance recovery after zygomatic trauma: A parallel controlled clinical trial. Journal of Photochemistry and Photobiology B: Biology. 2021 Apr 1; 217: 112153. PMid: 33640829. https://doi.org/10.1016/j.jphotobiol.2021.112153
  22. Sirintawat N, Sawang K, Chaiyasamut T, Wongsirichat N. Pain measurement in oral and maxillofacial surgery. Journal of dental anesthesia and pain medicine. 2017 Dec; 17(4): 253. PMid: 29349347. PMCid: PMC5766084. https://doi.org/10.17245/jdapm.2017.17.4.253
  23. Shakin VN, Semyonova TI, Kudryashova AY, Frisk VV. Comparison of Computer Modeling of RC Filter in Matlab and Scilab Environments. In: 2020 Wave Electronics and its Application in Information and Telecommunication Systems (WECONF) 2020 Jun 1. 2020: p. 1-5. https://doi.org/10.1109/WECONF48837.2020.9131473
  24. Manohar K, Sravani K, Ponnapalli VS. An Investigation on Scilab Software for the Design of Transform Techniques and Digital Filters. In: 2021 International Conference on Computer Communication and Informatics (ICCCI) 2021 Jan 27. 2021: p. 1-5.
  25. Kiselev IV. Comparative analysis of libraries for computer vision OpenCV and AForge. NET for use in gesture recognition system. Journal of Physics: Conference Series. 2020 Nov 1; 1661(1): 012048. https://doi.org/10.1088/1742-6596/1661/1/012048
  26. Lozano Domínguez JM, Mateo Sanguino TD. Walking Secure: Safe Routing Planning Algorithm and Pedestrian's Crossing Intention Detector Based on Fuzzy Logic App. Sensors. 2021 Jan; 21(2): 529. PMid: 33451012. PMCid: PMC7828533. https://doi.org/10.3390/s21020529
  27. Yager RR, Filev DP. Essentials of Fuzzy Modeling and Control. NY: John and Wiley and Sons Inc.; 1994. 408 p.
  28. Shtovba SD. Design of fuzzy systems by means of MATLAB. M: Hotline-Telecom; 2007. 288 p.
  29. Bezdek JC, Keller J, Krisnapuram R, Pal N. Fuzzy models and algorithms for pattern recognition and image processing. Springer Science & Business Media; 1999 Aug 31. https://doi.org/10.1007/b106267
  30. Ghosh R, Gopalkrishnan K. Facial fractures. Journal of craniofacial surgery. 2018 Jun 1; 29(4): e334-40. PMid: 29381610. https://doi.org/10.1097/SCS.0000000000004269
  31. Gareb B, Roossien CC, van Bakelen NB, Verkerke GJ, Vissink A, Bos RR, et al. Comparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery. Scientific reports. 2020 Oct 23; 10(1): 1-8. PMid: 33097757. PMCid: PMC7584639. https://doi.org/10.1038/s41598-020-75299-9
  32. El-Hadidy AM. The use of a Foley catheter in isolated zygomatic arch fractures. Plastic and reconstructive surgery. 2005 Sep 1; 116(3): 853-6. PMid: 16141826. https://doi.org/10.1097/01.prs.0000176896.60094.c8
  33. Gray LN, Kalimuthu R, Jayaram B, Lewis N, Sohaey M. A retrospective study of treatment of orbital floor fractures with the maxillary sinus approach. British journal of plastic surgery. 1985 Jan 1; 38(1): 113-5. https://doi.org/10.1016/0007-1226(85)90097-9
  34. Sukegawa S, Masui M, Sukegawa-Takahashi Y, Nakano K, Takabatake K, Kawai H, et al. Maxillofacial Trauma Surgery Patients With Titanium Osteosynthesis Miniplates: Remove or Not? Journal of Craniofacial Surgery. 2020 Jul 1; 31(5): 1338-42. PMid: 32371694. https://doi.org/10.1097/SCS.0000000000006352
  35. Kademani D, Tiwana P. Atlas of oral and maxillofacial surgery. Elsevier Health Sciences; 2015 Apr 9. 1520 p.
  36. Ahmad WM, Noor NF, Shaari R, Nawi MA, Ghazali FM, Aleng NA, et al. The Most Common Relationship of a Midface Fracture in Maxillofacial Trauma Study. The Journal of Craniofacial Surgery. 2021 Mar 25. PMid: 33852515. https://doi.org/10.1097/SCS.0000000000007435
  37. Erol B, Tanrikulu R, Görgün B. Maxillofacial fractures. Analysis of demographic distribution and treatment in 2901 patients (25-year experience). Journal of Cranio-Maxillofacial Surgery. 2004 Oct 1; 32(5): 308-13. PMid: 15458673. https://doi.org/10.1016/j.jcms.2004.04.006
  38. Riviș M, Roi C, Roi A, Nica D, Văleanu A, Rusu LC. The Implications of Titanium Alloys Applied in Maxillofacial Osteosynthesis. Applied Sciences. 2020 Jan; 10(9): 3203. https://doi.org/10.3390/app10093203
  39. Costan VV, Nicolau A, Sulea D, Ciofu ML, Boișteanu O, Popescu E. The Impact of 3D Technology in Optimizing Midface Fracture Treatment-Focus on the Zygomatic Bone. Journal of Oral and Maxillofacial Surgery. 2021 Apr 1; 79(4): 880-91. PMid: 33279472. https://doi.org/10.1016/j.joms.2020.11.004
  40. Sikora M, Chęciński M, Sielski M, Chlubek D. The Use of 3D Titanium Miniplates in Surgical Treatment of Patients with Condylar Fractures. Journal of Clinical Medicine. 2020 Sep; 9(9): 2923. PMid: 32927799. PMCid: PMC7563735. https://doi.org/10.3390/jcm9092923
  41. Mehrotra D. Fundamentals of Oral and Maxillofacial Surgery. India: Elsevier Health Sciences; 2020 Jun 2. 650 p.