Craniomaxillofacial Trauma & Reconstruction

5 pages, 94 KiB

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The Comprehensive AOCMF Classification System: Glossary of Common Terminology

by Carl-Peter Cornelius, Laurent Audigé, Christoph Kunz and Joachim Prein

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 136-140; https://doi.org/10.1055/s-0034-1390072 - 1 Dec 2014

Cited by 6 | Viewed by 104

Terminology in the context of this series of tutorial papers outlining the comprehensive AOCMF classification system complieswith special perspectives [...] Full article

5 pages, 84 KiB

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The Comprehensive AOCMF Classification System: Fracture Case Collection, Diagnostic Imaging Work Up, AOCOIAC Iconography and Coding

by Carl-Peter Cornelius, Christoph Kunz, Andreas Neff, Robert M. Kellman, Joachim Prein and Laurent Audigé

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 131-135; https://doi.org/10.1055/s-0034-1393722 - 1 Dec 2014

Cited by 25 | Viewed by 93

Abstract

The AO classification system for fractures in the adult craniomaxillofacial (CMF) skeleton is organized in anatomic modules in a 3 precision-level hierarchy with account for an increasing complexity and details. Level-1 is most elementary and identifies no more than the presence of fractures [...] Read more.

The AO classification system for fractures in the adult craniomaxillofacial (CMF) skeleton is organized in anatomic modules in a 3 precision-level hierarchy with account for an increasing complexity and details. Level-1 is most elementary and identifies no more than the presence of fractures in 4 separate anatomical units: the mandible (code 91), midface (92), skull base (93) and cranial vault (94). Level-2 relates the detailed topographic location of the fractures within defined regions of the mandible, central and lateral midface, internal orbit, endo- and exocranial skull base, and the cranial vault. Level-3 is based on an even more refined topographic assessment and focuses on the morphology—fragmentation, displacement, and bone defects—within specified subregions. An electronic fracture case collection complements the preceding tutorial papers, which explain the features and options of the AOCMF classification system in this issue of the Journal. The electronic case collection demonstrates a range of representative osseous CMF injuries on the basis of diagnostic images, narrative descriptions of the fracture diagnosis and their classification using the icons for illustration and coding of a dedicated software AOCOIAC (AO Comprehensive Injury Automatic Classifier). Ninety four case examples are listed in two tables for a fast overview of the electronic content. Each case can serve as a guide to getting started with the new AOCMF classification system using AOCOIAC software and to employ it in the own clinical practice. Full article

8 pages, 368 KiB

Open AccessArticle

The Comprehensive AOCMF Classification System: Radiological Issues and Systematic Approach

by Carlos H. Buitrago-Téllez, Carl-Peter Cornelius, Joachim Prein, Christoph Kunz, Antonio Di Ieva and Laurent Audigé

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 123-130; https://doi.org/10.1055/s-0034-1389565 - 1 Dec 2014

Cited by 14 | Viewed by 118

Abstract

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) classification system with increasing level of complexity and details. The basic level 1 system differentiates fracture location in the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code [...] Read more.

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) classification system with increasing level of complexity and details. The basic level 1 system differentiates fracture location in the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94); the levels 2 and 3 focus on defining fracture location and morphology within more detailed regions and subregions. Correct imaging acquisition, systematic analysis, and interpretation according to the anatomic and surgical relevant structures in the CMF regions are essential for an accurate, reproducible, and comprehensive diagnosis of CMF fractures using that system. Basic principles for radiographic diagnosis are based on conventional plain films, multidetector computed tomography, and magnetic resonance imaging. In this tutorial, the radiological issues according to each level of the classification are described. Full article

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9 pages, 781 KiB

Open AccessArticle

The Comprehensive AOCMF Classification System: Classification and Documentation within AOCOIAC Software

by Laurent Audigé, Carl-Peter Cornelius, Christoph Kunz, Carlos H. Buitrago-Téllez and Joachim Prein

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 114-122; https://doi.org/10.1055/s-0034-1389564 - 1 Dec 2014

Cited by 18 | Viewed by 130

Abstract

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) fracture classification system. The fundamental level 1 distinguishes four major anatomical units including the mandible (code 91), midface (code 92), skull base (code 93) and cranial vault (code 94); level 2 relates to [...] Read more.

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) fracture classification system. The fundamental level 1 distinguishes four major anatomical units including the mandible (code 91), midface (code 92), skull base (code 93) and cranial vault (code 94); level 2 relates to the location of the fractures within defined topographical regions within each units; level 3 relates to fracture morphology in these regions regarding fragmentation, displacement, and bone defects, as well as the involvement of specific anatomical structures. The resulting CMF classification system has been implemented into AO comprehensive injury automatic classifier (AOCOIAC) software allowing for fracture classification as well as clinical documentation of individual cases including a selected sample of diagnostic images. This tutorial highlights the main features of the software. In addition, a series of illustrative case examples is made available electronically for viewing and editing. Full article

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11 pages, 602 KiB

Open AccessArticle

The Comprehensive AOCMF Classification: Skull Base and Cranial Vault Fractures—Level 2 and 3 Tutorial

by Antonio Di Ieva, Laurent Audigé, Robert M. Kellman, Kevin A. Shumrick, Helmut Ringl, Joachim Prein and Christian Matula

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 103-113; https://doi.org/10.1055/s-0034-1389563 - 1 Dec 2014

Cited by 11 | Viewed by 90

Abstract

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units, including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault [...] Read more.

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units, including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). This tutorial presents the level 2 and more detailed level 3 systems for the skull base and cranial vault units. The level 2 system describes fracture location outlining the topographic boundaries of the anatomic regions, considering in particular the endocranial and exocranial skull base surfaces. The endocranial skull base is divided into nine regions; a central skull base adjoining a left and right side are divided into the anterior, middle, and posterior skull base. The exocranial skull base surface and cranial vault are divided in regions defined by the names of the bones involved: frontal, parietal, temporal, sphenoid, and occipital bones. The level 3 system allows assessing fracture morphology described by the presence of fracture fragmentation, displacement, and bone loss. A documentation of associated intracranial diagnostic features is proposed. This tutorial is organized in a sequence of sections dealing with the description of the classification system with illustrations of the topographical skull base and cranial vault regions along with rules for fracture location and coding, a series of case examples with clinical imaging and a general discussion on the design of this classification. Full article

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11 pages, 672 KiB

Open AccessArticle

The Comprehensive AOCMF Classification System: Orbital Fractures—Level 3 Tutorial

by Christoph Kunz, Laurent Audigé, Carl-Peter Cornelius, Carlos H. Buitrago-Téllez, Randal Rudderman and Joachim Prein

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 92-102; https://doi.org/10.1055/s-0034-1389562 - 1 Dec 2014

Cited by 29 | Viewed by 119

Abstract

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. Within the midface (level 1 code 92), the level 2 system describes the location of the fractures within defined regions in the central and lateral [...] Read more.

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. Within the midface (level 1 code 92), the level 2 system describes the location of the fractures within defined regions in the central and lateral midface including the internal orbit. This tutorial outlines the level 3 detailed classification system for fractures of the orbit. It depicts the orbital fractures according to the subregions defined as orbital rims, anterior orbital walls, midorbit, and apex. The system allows documentation of the involvement of specific orbital structures such as inferior orbital fissure, internal orbital buttress, the greater wing of sphenoid, lacrimal bone, superior orbital fissure, and optic canal. The classification system is presented along with rules for fracture location and coding, a series of case examples with clinical imaging and a general discussion on the design of this classification. Full article

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24 pages, 1478 KiB

Open AccessArticle

The Comprehensive AOCMF Classification System: Midface Fractures—Level 3 Tutorial

by Carl-Peter Cornelius, Laurent Audigé, Christoph Kunz, Carlos H. Buitrago-Téllez, Randal Rudderman and Joachim Prein

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 68-91; https://doi.org/10.1055/s-0034-1389561 - 1 Dec 2014

Cited by 17 | Viewed by 212

Abstract

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the midface at the precision level 3. The topography of the different midface regions (central midface—upper central midface, intermediate central midface, lower central midface—incorporating the naso-orbito-ethmoid region; lateral midface—zygoma [...] Read more.

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the midface at the precision level 3. The topography of the different midface regions (central midface—upper central midface, intermediate central midface, lower central midface—incorporating the naso-orbito-ethmoid region; lateral midface—zygoma and zygomatic arch, palate) is subdivided in much greater detail than in level 2 going beyond the Le Fort fracture types and its analogs. The level 3 midface classification system is presented along with guidelines to precisely delineate the fracture patterns in these specific subregions. It is easy to plot common fracture entities, such as nasal and naso-orbito-ethmoid, and their variants due to the refined structural layout of the subregions. As a key attribute, this focused approach permits to document the occurrence of fragmentation (i.e., single vs. multiple fracture lines), displacement, and bone loss. Moreover, the preinjury dental state and the degree of alveolar atrophy in edentulous maxillary regions can be recorded. On the basis of these individual features, tooth injuries, periodontal trauma, and fracture involvement of the alveolar process can be assessed. Coding rules are given to set up a distinctive formula for typical midface fractures and their combinations. The instructions and illustrations are elucidated by a series of radiographic imaging examples. A critical appraisal of the design of this level 3 midface classification is made. Full article

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9 pages, 523 KiB

Open AccessArticle

The Comprehensive AOCMF Classification System: Midface Fractures—Level 2 Tutorial

by Christoph Kunz, Laurent Audigé, Carl-Peter Cornelius, Carlos H. Buitrago-Téllez, John Frodel, Randal Rudderman and Joachim Prein

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 59-67; https://doi.org/10.1055/s-0034-1389560 - 1 Dec 2014

Cited by 22 | Viewed by 146

Abstract

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault [...] Read more.

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). This tutorial presents the level 2 system for the midface unit that concentrates on the location of the fractures within defined regions in the central (upper, intermediate, and lower) and lateral (zygoma, pterygoid) midface, as well as the internal orbit and palate. The level 2 midface fracture location outlines the topographic boundaries of the anatomical regions. The common nasoorbitoethmoidal and zygoma en bloc fracture patterns, as well as the time-honored Le Fort classification are taken into account. This tutorial is organized in a sequence of sections dealing with the description of the classification system with illustrations of the topographical cranial midface regions along with rules for fracture location and coding, a series of case examples with clinical imaging and a general discussion on the design of this classification. Individual fracture mapping in these regions regarding severity, fragmentation, displacement of the fragment or bone defect is addressed in a more detailed level 3 system in the subsequent articles. Full article

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15 pages, 742 KiB

Open AccessArticle

The Comprehensive AOCMF Classification System: Condylar Process Fractures—Level 3 Tutorial

by Andreas Neff, Carl-Peter Cornelius, Michael Rasse, Daniel Dalla Torre and Laurent Audigé

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 44-58; https://doi.org/10.1055/s-0034-1389559 - 1 Dec 2014

Cited by 108 | Viewed by 289

Abstract

This tutorial outlines the detailed system for fractures of the condylar process at the precision level 3 and is organized in a sequence of sections dealing with the description of the classification system within topographical subdivisions along with rules for fracture coding and [...] Read more.

This tutorial outlines the detailed system for fractures of the condylar process at the precision level 3 and is organized in a sequence of sections dealing with the description of the classification system within topographical subdivisions along with rules for fracture coding and a series of case examples with clinical imaging. Basically, the condylar process comprises three fracture levels and is subdivided into the head region, the condylar neck, and the condylar base. Fractures of the condylar head show typical fracture lines either within the lateral pole zone, which may lead to loss of vertical height, or medially to the pole zone, with the latter ones usually not compromising the vertical condyle to fossa relation. In condylar head fractures, the morphology is further described by the presence of minor or major fragmentation, the vertical apposition of fragments at the plane of the head fracture, the displacement of the condylar head with regard to the fossa including a potential distortion of the condylar head congruency resulting in dystopic condyle to fossa relations and the presence or absence of a loss of vertical ramus height. A specific vertical fracture pattern extending from the head to the neck or base subregion is considered. Fractures of the condylar neck and base can be differentiated according to a newly introduced one-third to two-thirds rule with regard to the proportion of the fracture line above and below the level of the sigmoid notch, which is presented in the classification article, and are basically subdivided according to the presence or absence of displacement or dislocation. In both condylar neck and base fractures, the classification is again based on the above mentioned parameters such as fragmentation, displacement of the condylar head with regard to the fossa, including dystopic condyle to fossa relations and loss of vertical ramus height, that is, according to the measurement of the condylar process. In addition, the classification assesses a sideward displacement including the respective displacement sector at the neck or base fracture site as well as the angulation of the superior main fragment and also considers a potential displacement of the caudal fragment with regard to the fossa, which may occur in fractures affecting additional fracture locations in the mandible. The design of this classification is discussed along with a review of existing classification systems. The condylar process for fracture location was defined according to the level 2 system presented in a previous tutorial in this special issue. Full article

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13 pages, 761 KiB

Open AccessArticle

The Comprehensive AOCMF Classification System: Mandible Fractures-Level 3 Tutorial

by Carl-Peter Cornelius, Laurent Audigé, Christoph Kunz, Randal Rudderman, Carlos H. Buitrago-Téllez, John Frodel and Joachim Prein

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 31-43; https://doi.org/10.1055/s-0034-1389558 - 1 Dec 2014

Cited by 20 | Viewed by 168

Abstract

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandibular arch (i.e., the non-condylar mandible) at the precision level 3. It is the logical expansion of the fracture allocation to topographic mandibular sites outlined in level 2, [...] Read more.

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandibular arch (i.e., the non-condylar mandible) at the precision level 3. It is the logical expansion of the fracture allocation to topographic mandibular sites outlined in level 2, and is based on three-dimensional (3D) imaging techniques/computed tomography (CT)/cone beam CT). Level 3 allows an anatomical description of the individual conditions of the mandibular arch such as the preinjury dental state and the degree of alveolar atrophy. Trauma sequelae are then addressed: (1) tooth injuries and periodontal trauma, (2) fracture involvement of the alveolar process, (3) the degree of fracture fragmentation in three categories (none, minor, and major), and (4) the presence of bone loss. The grading of fragmentation needs a 3D evaluation of the fracture area, allowing visualization of the outer and inner mandibular cortices. To document these fracture features beyond topography the alphanumeric codes are supplied with distinctive appendices. This level 3 tutorial is accompanied by a brief survey of the peculiarities of the edentulous atrophic mandible. Illustrations and a few case examples serve as instruction and reference to improve the understanding and application of the presented features. Full article

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16 pages, 674 KiB

Open AccessArticle

The Comprehensive AOCMF Classification System: Mandible Fractures—Level 2 Tutorial

by Carl-Peter Cornelius, Laurent Audigé, Christoph Kunz, Randal Rudderman, Carlos H. Buitrago-Téllez, John Frodel and Joachim Prein

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 15-30; https://doi.org/10.1055/s-0034-1389557 - 1 Dec 2014

Cited by 25 | Viewed by 216

Abstract

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandible at the precision level 2 allowing description of their topographical distribution. A short introduction about the anatomy is made. Mandibular fractures are classified by the anatomic regions [...] Read more.

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandible at the precision level 2 allowing description of their topographical distribution. A short introduction about the anatomy is made. Mandibular fractures are classified by the anatomic regions involved. For this purpose, the mandible is delineated into an array of nine regions identified by letters: the symphysis/parasymphysis region anteriorly, two body regions on each lateral side, combined angle and ascending ramus regions, and finally the condylar and coronoid processes. A precise definition of the demarcation lines between these regions is given for the unambiguous allocation of fractures. Four transition zones allow an accurate topographic assignment if fractures end up in or run across the borders of anatomic regions. These zones are defined between angle/ramus and body, and between body and symphysis/parasymphysis. A fracture is classified as “confined” as long as it is located within a region, in contrast to a fracture being “nonconfined” when it extents to an adjoining region. Illustrations and case examples of mandible fractures are presented to become familiar with the classification procedure in daily routine. Full article

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9 pages, 219 KiB

Open AccessIntroduction

The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives

by Laurent Audigé, Carl-Peter Cornelius, Antonio Di Ieva, Joachim Prein and CMF Classification Group

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 6-14; https://doi.org/10.1055/s-0034-1389556 - 1 Dec 2014

Cited by 18 | Viewed by 153

Abstract

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a [...] Read more.

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal. Full article

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2 pages, 45 KiB

Open AccessIntroduction

The First Comprehensive AO Classification System for Fractures of the Craniomaxillofacial Skeleton

by Joachim Prein and Laurent Audigé

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 4-5; https://doi.org/10.1055/s-0034-1390323 - 1 Dec 2014

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Abstract

The AO Foundation has a long history of involvement in the development, validation, education, and documentation in the field of surgical fracture treatment [...] Full article

3 pages, 180 KiB

Open AccessIntroduction

CMF Classification

by Paul N. Manson, Larry Hollier and Warren Schubert

Craniomaxillofac. Trauma Reconstr. 2014, 7(s1), 1-3; https://doi.org/10.1055/s-0034-1390071 - 1 Dec 2014

Cited by 1 | Viewed by 105

Abstract

This edition of Craniomaxillofacial Trauma and Reconstruction contains a special Supplement on the work of Audige, Cornelius, Di Leva, Prein and the AO CMF Classification Committee over a period greater than 10 years [...] Full article

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Craniomaxillofac. Trauma Reconstr., Volume 7, Issue s1 (December 2014) – 14 articles

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