![]() ![]() Illustrations are provided along with rules to assist the reader in making appropriate choices and the associated coding. In addition, the recording of associated intracranial features is considered for complete clinically relevant description of the injuries. Further characterization of the fracture morphology is presented considering the presence of fracture fragmentation, fracture displacement, and bone loss (level 3 system). 1 In this tutorial, the level 2 system allocation of fractures to topographical regions of the skull base and cranial vault is described. Level 1, an elementary system for fracture location, is appropriate for all trauma surgeons to describe the fractures that affect the midface as one of the four main anatomical units of the facial skeleton: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). The AOCMF fracture classification is based on different precision levels. Therefore, we are proposing a classification system for fractures of the skull base and cranial vault for use in clinical settings to support their diagnosis and documentation, which eventually would help in their management. The lack of universally accepted and validated classification systems for skull base and cranial vault fractures hampers our ability to compare results among surgeons and institutions, and thus it makes it difficult to determine the best treatment approaches for patients with head injuries. 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. A documentation of associated intracranial diagnostic features is proposed. The level 3 system allows assessing fracture morphology described by the presence of fracture fragmentation, displacement, and bone loss. 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 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 level 2 system describes fracture location outlining the topographic boundaries of the anatomic regions, considering in particular the endocranial and exocranial skull base surfaces. This tutorial presents the level 2 and more detailed level 3 systems for the skull base and cranial vault units. 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). The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. ![]()
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