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

Author:

Di Ieva Antonio1,Audigé Laurent23,Kellman Robert M.4,Shumrick Kevin A.5,Ringl Helmut6,Prein Joachim7,Matula Christian8

Affiliation:

1. Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada

2. AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland

3. Research and Development Department, Schulthess Clinic, Zürich, Switzerland

4. Department of Otolarynology-Head and Neck Surgery, SUNY Upstate Medical University, Syracuse, New York

5. Group Health Associates, Cincinnati, Ohio

6. Department of Radiology, Medical University of Vienna, Vienna, Austria

7. Clinic for Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland

8. Department of Neurosurgery, Medical University of Vienna, Vienna, Austria

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 (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.

Publisher

SAGE Publications

Subject

Otorhinolaryngology,Oral Surgery,Surgery

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2. Head;Forensic Aspects of Paediatric Fractures;2023

3. Pediatric basilar skull fractures from multi-level falls: A systematic review and retrospective analysis;International Journal of Pediatric Otorhinolaryngology;2022-11

4. Traumatic skull fractures in dogs and cats: A comparative analysis of neurological and computed tomographic features;Journal of Veterinary Internal Medicine;2020-07-20

5. Coincidence of craniocerebral and craniofacial injuries;Journal of Cranio-Maxillofacial Surgery;2019-02

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