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

Cornelius, Carl‐Peter; Audigé, Laurent; Kunz, Christoph; Rudderman, Randal; Buitrago-Téllez, C.; Frodel, John L.; Prein, Joachim

doi:10.1055/s-0034-1389558

Cited by 32 publications

(42 citation statements)

References 25 publications

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“…There are no transitional zones in between the partitions, as they were defined in the level 3 mandible classification module. 15 The nasal skeleton is represented within the UCM including the upper septum, whereas the lower septum is included within in the LCM. Fractures of the nasal skeleton occur either isolated or in connection with Le Fort II and III fractures or NOE fractures (►Figs.…”

Section: Discussionmentioning

confidence: 99%

“…The nomenclature to describe the dental sequelae of a midfacial injury follows the same scheme as used in the level 3 system for mandibular fractures. 15 The FDI (Fédération Dentaire Internationale) two-digit tooth numbering formula for permanent teeth is used to register the likely preinjury dental status (absent teeth before trauma) (►Fig. 3).…”

Section: Dentitionmentioning

confidence: 99%

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

Cornelius

Audigé

Kunz

et al. 2014

Craniomaxillofacial Trauma & Reconstruction

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Fractures of the midface occur in a high variety of fracture patterns and are difficult to classify appropriately to assign standardized categories of fracture classes reflecting the injury status of the patient. Requirements for a fracture classification are its clinical relevance and the ability to provide reliable and reproducible means to communicate Keywords ► fracture classification ► midface ► anatomic regions AbstractThe 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.

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Section: Discussionmentioning

confidence: 99%

Section: Dentitionmentioning

confidence: 99%

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

Cornelius

Audigé

Kunz

et al. 2014

Craniomaxillofacial Trauma & Reconstruction

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“…4 The purpose of this study was to validate the three modules of the AO CMF classification system for mandible fractures by a group of assessors from four centers in high-resource countries. 1,5,6 Historically, several schemes were published to classify mandible fractures. Most of them have primarily focused on the topographical location of the fractures, with varying definitions of the mandibular regions and subregions.…”

Section: Discussionmentioning

confidence: 99%

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

Mittermiller

Bidwell

Thieringer

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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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.

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“…An alveolar process fracture is defined as a fracture that is between the two distinct vertical fracture lines at variable distance from each other and by an interconnecting horizontal fracture line running through the apical base . A free fragment with two or more teeth displaced is indicated in a typical presentation of the segmental alveolar fracture.…”

Section: Discussionmentioning

confidence: 99%

Osteosynthesis of segmental alveolar fractures by internal fixation and the prognosis of the fractures and teeth

Zhou

Xing

Yang

et al. 2019

Dental Traumatology

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Background/Aims: Fracture of the alveolar process is a common injury, but the traditional splinting fixation may not be possible in some cases. The aim of this study was to describe the osteosynthesis performed in segmental alveolar fractures by internal fixation and evaluate the prognosis of the fractures and teeth involved. Materials and methods: Twenty-two patients who were identified as having segmental alveolar fractures treated with osteosynthesis by internal fixation at the authors' department from January 2007 to December 2016 were included with 90 traumatized teeth. The prognosis of the fractures and teeth involved in the fractures was evaluated by the post-operative computed tomography combined with a follow-up study.

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

Cited by 32 publications

References 25 publications

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

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

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

Osteosynthesis of segmental alveolar fractures by internal fixation and the prognosis of the fractures and teeth

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