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

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 131-135 ◽  
Author(s):  
Carl-Peter Cornelius ◽  
Christoph Kunz ◽  
Andreas Neff ◽  
Robert M. Kellman ◽  
Joachim Prein ◽  
...  
Keyword(s):  
Skull Base ◽  
Classification System ◽  
Cranial Vault ◽  
Ao Classification ◽  
Case Examples ◽  
Fracture Diagnosis ◽  
Level 3 ◽  
Case Collection ◽  
Electronic Content ◽  
Work Up

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.

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

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 103-113 ◽  
Author(s):  
Antonio Di Ieva ◽  
Laurent Audigé ◽  
Robert M. Kellman ◽  
Kevin A. Shumrick ◽  
Helmut Ringl ◽  
...  
Keyword(s):  
Skull Base ◽  
Classification System ◽  
Fracture Morphology ◽  
Cranial Vault ◽  
Diagnostic Features ◽  
Base Surface ◽  
Case Examples ◽  
Fracture Location ◽  
Level 3 ◽  
Level 2

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.

scholarly journals The Comprehensive AOCMF Classification System: Midface Fractures - Level 2 Tutorial

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 59-67 ◽  
Author(s):  
Christoph Kunz ◽  
Laurent Audigé ◽  
Carl-Peter Cornelius ◽  
Carlos H. Buitrago-Téllez ◽  
John Frodel ◽  
...  
Keyword(s):  
Classification System ◽  
En Bloc ◽  
Case Examples ◽  
Fracture Location ◽  
Midface Fracture ◽  
Level 3 ◽  
The Common ◽  
Fracture Mapping ◽  
Le Fort Classification ◽  
Level 2

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.

scholarly journals The Comprehensive AOCMF Classification System: Orbital Fractures - Level 3 Tutorial

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 92-102 ◽  
Author(s):  
Christoph Kunz ◽  
Laurent Audigé ◽  
Carl-Peter Cornelius ◽  
Carlos H. Buitrago-Téllez ◽  
Randal Rudderman ◽  
...  
Keyword(s):  
Classification System ◽  
Orbital Fractures ◽  
Superior Orbital Fissure ◽  
Case Examples ◽  
Detailed Classification ◽  
Level 3 ◽  
Lacrimal Bone ◽  
Level 1 ◽  
Level 2 ◽  
Inferior Orbital Fissure

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.

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

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 114-122 ◽  
Author(s):  
Laurent Audigé ◽  
Carl-Peter Cornelius ◽  
Christoph Kunz ◽  
Carlos H. Buitrago-Téllez ◽  
Joachim Prein
Keyword(s):  
Classification System ◽  
Fracture Morphology ◽  
Illustrative Case ◽  
Clinical Documentation ◽  
Fracture Classification ◽  
Anatomical Structures ◽  
Case Examples ◽  
Level 3 ◽  
Level 1 ◽  
Level 2

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.

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

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 31-43 ◽  
Author(s):  
Carl-Peter Cornelius ◽  
Laurent Audigé ◽  
Christoph Kunz ◽  
Randal Rudderman ◽  
Carlos H. Buitrago-Téllez ◽  
...  
Keyword(s):  
Classification System ◽  
Imaging Techniques ◽  
Cone Beam Ct ◽  
Three Dimensional ◽  
Case Examples ◽  
Mandibular Arch ◽  
Level 3 ◽  
Mandible Fractures ◽  
The Individual ◽  
Trauma Sequelae

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.

Surgery for Skull Base Malignancies-Preoperative Work-Up to Minimize Complications

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
Andrew King ◽  
Stephen MacNally ◽  
Jarod Homer ◽  
Richard Ramsden ◽  
Shakeel Saeed ◽  
...  
Keyword(s):  
Skull Base ◽  
Preoperative Work Up ◽  
Work Up

scholarly journals Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

2018 ◽  
Vol 45 (1) ◽  
pp. E5 ◽  
Author(s):  
Sunil Manjila ◽  
Timothy Bazil ◽  
Matthew Kay ◽  
Unni K. Udayasankar ◽  
Maroun Semaan
Keyword(s):  
Skull Base ◽  
Middle Ear ◽  
Classification System ◽  
Internal Auditory Canal ◽  
Imaging Study ◽  
Jugular Bulb ◽  
Anatomical Location ◽  
Inferior Margin ◽  
Consensus Classification ◽  
Type 3

OBJECTIVEThere is no definitive or consensus classification system for the jugular bulb position that can be uniformly communicated between a radiologist, neurootologist, and neurosurgeon. A high-riding jugular bulb (HRJB) has been variably defined as a jugular bulb that rises to or above the level of the basal turn of the cochlea, within 2 mm of the internal auditory canal (IAC), or to the level of the superior tympanic annulus. Overall, there is a seeming lack of consensus, especially when MRI and/or CT are used for jugular bulb evaluation without a dedicated imaging study of the venous anatomy such as digital subtraction angiography or CT or MR venography.METHODSA PubMed analysis of “jugular bulb” comprised of 1264 relevant articles were selected and analyzed specifically for an HRJB. A novel classification system based on preliminary skull base imaging using CT is proposed by the authors for conveying the anatomical location of the jugular bulb. This new classification includes the following types: type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (SCC), subclassified as type 2a (without dehiscence into the middle ear) or type 2b (with dehiscence into the middle ear); type 3, between the inferior margin of the posterior SCC and the inferior margin of the IAC, subclassified as type 3a (without dehiscence into the middle ear) and type 3b (with dehiscence into the middle ear); type 4, above the inferior margin of the IAC, subclassified as type 4a (without dehiscence into the IAC) and type 4b (with dehiscence into the IAC); and type 5, combination of dehiscences. Appropriate CT and MR images of the skull base were selected to validate the criteria and further demonstrated using 3D reconstruction of DICOM files. The microsurgical significance of the proposed classification is evaluated with reference to specific skull base/posterior fossa pathologies.RESULTSThe authors validated the role of a novel classification of jugular bulb location that can help effective communication between providers treating skull base lesions. Effective utilization of the above grading system can help plan surgical procedures and anticipate complications.CONCLUSIONSThe authors have proposed a novel anatomical/radiological classification system for jugular bulb location with respect to surgical implications. This classification can help surgeons in complication avoidance and management when addressing HRJBs.

CT and MR Imaging of Lesions of Skull Base and Cranial Vault

1989 ◽  
pp. 459-486
Author(s):  
Claus Claussen ◽  
Rudolf Fahlbusch ◽  
Roland Felix ◽  
Thomas Grumme ◽  
Jürgen Heinzerling ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Skull Base ◽  
Cranial Vault

scholarly journals The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study

2019 ◽  
Vol 12 (4) ◽  
pp. 254-265 ◽  
Author(s):  
Paul A. Mittermiller ◽  
Serena S. Bidwell ◽  
Florian M. Thieringer ◽  
Carl-Peter Cornelius ◽  
Amber W. Trickey ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Reliability ◽  
Fracture Morphology ◽  
Mandibular Fractures ◽  
Condylar Process ◽  
Accuracy Study ◽  
Level 3 ◽  
Comprehensive Classification ◽  
Level 2 ◽  
Condylar Neck

The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence of fractures in four anatomic areas (mandible, midface, skull base, and cranial vault). Level 2 variables describe the location of the fractures within those defined areas. Level 3 variables describe details of fracture morphology such as fragmentation, displacement, and dislocation. This multiplanar radiographic image-based AO CMF trauma classification system is constantly evolving and beginning to enter worldwide application. A validation of the system is mandatory prior to a reliable communication and data processing in clinical and research environments. This interobserver reliability and accuracy study is aiming to validate the three current modules of the AO CMF classification system for mandible trauma in adults. To assess the performance of the system at the different precision levels, it focuses on the fracture location within the mandibular regions and condylar process subregions as core components giving only secondary attention to morphologic variables. A total of 15 subjects individually assigned the location and features of mandibular fractures in 200 CT scans using the AO CMF classification system. The results of these ratings were then statistically evaluated for interobserver reliability by Fleiss’ kappa and accuracy by percentage agreement with an experienced reference assessor. The scores were used to determine if the variables of levels 2 and 3 were appropriate tools for valid classification. Interobserver reliability and accuracy were compared by hierarchy of variables (level 2 vs. level 3), by anatomical region and subregion, and by assessor experience level using Kruskal-Wallis and Wilcoxon's rank-sum tests. The AO CMF classification system was determined to be reliable and accurate for classifying mandibular fractures for most levels 2 and 3 variables. Level 2 variables had significantly higher interobserver reliability than level 3 variables (median kappa: 0.69 vs. 0.59, p < 0.001) as well as higher accuracy (median agreement: 94 vs. 91%, p < 0.001). Accuracy was adequate for most variables, but lower reliability was observed for condylar head fractures, fragmentation of condylar neck fractures, displacement types and direction of the condylar process overall, as well as the condylar neck and base fractures. Assessors with more clinical experience demonstrated higher reliability (median kappa high experience 0.66 vs. medium 0.59 vs. low 0.48, p < 0.001). Assessors with experience using the classification software also had higher reliability than their less experienced counterparts (median kappa: 0.76 vs. 0.57, p < 0.001). At present, the AO CMF classification system for mandibular fractures is suited for both clinical and research settings for level 2 variables. Accuracy and reliability decrease for level 3 variables specifically concerning fractures and displacement of condylar process fractures. This will require further investigation into why these fractures were characterized unreliably, which would guide modifications of the system and future instructions for its usage.

scholarly journals Tailored Extended Bifrontal Craniotomy for Anterior Skull Base Tumors: Anatomic Description of a Modified Surgical Technique and Case Series

2017 ◽  
Vol 14 (4) ◽  
pp. 386-394 ◽  
Author(s):  
Michael M Safaee ◽  
Michael W McDermott ◽  
Arnau Benet ◽  
Philip V Theodosopoulos
Keyword(s):  
Skull Base ◽  
Frontal Lobe ◽  
Tomographic Reconstruction ◽  
Case Series ◽  
Early Postoperative Period ◽  
Anterior Skull Base ◽  
Skull Base Tumors ◽  
Case Examples ◽  
Computed Tomographic ◽  
Surgical Exposure

Abstract BACKGROUND Open transcranial approaches to the anterior skull base remain an integral component of current skull base practice. Evolution of these and other techniques has resulted in revisions of standard, tried-and-true methods in attempts to improve patient outcomes and cosmesis, while still providing the best combination of surgical exposure and ergonomics. OBJECTIVE To describe a modified approach for midline tumors of the anterior skull base. METHODS We describe the anatomy and techniques of a modified extended bifrontal craniotomy for anterior skull base tumors. Case examples and a postoperative 3-dimensional computed tomographic reconstruction of the craniotomy are provided. RESULTS The technique has been employed with success in 3 tuberculum sellae meningiomas where the anterior limit of the tumor is several centimeters back from the inner table of the frontal bone. The mean distance from the tumor to inner table was 2.8 cm (range 1.3-3.8 cm). Mean tumor dimensions were 3.0 cm (transverse), 3.5 cm (anterior-posterior), and 2.2 cm (craniocaudal). Average operative time was 557 min. No cases had new T2/fluid-attenuated inversion recovery magnetic resonance imaging signal of the inferior frontal lobe to indicate retraction injury. CONCLUSION The tailored extended bifrontal craniotomy for anterior skull base tumors provides adequate access to the anterior cranial fossa and has replaced our standard extended bifrontal approach. Keeping the osteotomy cut lines outside of the orbit reduces orbital swelling and mechanical disruption of conjugate eye movements in the early postoperative period, while allowing for minimal frontal lobe retraction and providing sufficient surgical exposure along the anterior skull base.

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