- aocmf
Contents
1. ee a r T ape i A SOTAA gt Wekre Laurent Aiiki AUL AG prsiy OCH E s Fagum Debs Help j u Training 4 Searching Bu Patients J History Praceres i AO Surpery melerence Online S MTR 91 008 CMTAR Appendix Case Collection 01 01 2012 O1 04 2012 TEKADE ariel Pra roie CH DI A TAS Conrad ta Lacu compe ALA 2 AO Foundation imoa ipen in edit mode on local computer 6 u e e 2E Cargo Dries Tome iota 1 fw La All Pretreatment Treatment Folow Up 1 gt Folow Up 2 Follow Up 3 Fod B Inaging Panama siy lengten Added by Prac deroa Deine Coreia OO Deecnption Panoranur radograph showing a single honcontal fracture within the angle j ramus Subdeesion on ihe left gde P piera cede LHe DU Aagi RA TA E Conii bii bee Local cirip hi Figure 7 Mandibular fracture documentation A After registering patient and trauma event using the patient tab fracture classification is implemented via the fracture tab B Case images and clinical history are documented using the history tab AOCOIAC was Buitrago craniofacial fracture automatic classifier software This software included initially only the mandible and was used to generate a fracture classi fication code without database for documentation It was extended to include the cranium at the initiation of the CMF classification project and was used for the evaluation of a CMF injury severity score i2. a Figure 4 Common midface fracture patterns available for classification Audig et al marked fractures and their features When a region or a subregion is set as fractured it will be colored in blue gt Fig 3 At the level 3 classification lack of fragmentation minor fragmentation or simply fragmentation in the cranium and major fragmentation in the mandible are show in yellow orange and red respectively Bone loss is shown with additional stripes The dentition status can be determined by selecting i e by double click the concerned tooth or teeth A classification window allows determining preinjury edentulism or tooth injuries loss fracture or loosening In case of edentulism the level of mandibular or maxillary atrophy can be set within the classification dialogue window of the concerned region This item remains disabled in case of full dentition Common fracture patterns in the midface including Le Fort LF types I II and III zygoma en bloc ZEB and nasoorbi toethmoidal NOE can be specified within the classification menu windows of the involved regions The regions involved in any specified pattern are highlighted in purple such as in bilateral LF patterns Fig 4 NOE and ZEB patterns are also illustrated within the detailed panoramic view of the midface After completion of the classification the fracture code is presented within the bottom right screen window Fig 5A Th
3. The ts Be 4 Not fractured Ble Factures Undetermined it Confined Net confined 1 Fragmented Minor u 2 Fragmented Major lift i No bone loss d Bone loss defect No atrophy Mild atrophy Ma cderate atrophy Sie Aay Ket fractured ji o Fractured i Tial E Undetermined v Confined Net corhmned D Net fragmented L Fragmented Minos F 7 Z Fragmented Major Ne bere lg d Bone loss defect Meo atrophy ir Hild atrophy Moderate abrophry Severe abophy Figure 3 Classification by fracture drawing or mouse click A A fractured region level 2 is set in blue B At the level 3 classification lack of fragmentation minor fragmentation or simply fragmentation in the cranium and major fragmentation in the mandible are show in yellow C orange and D red respectively D Partial edentulism and mild mandibular atrophy is illustrated Craniomaxillofacial Trauma and Reconstruction Vol 7 Suppl 1 2014 Downloaded by Thieme Verlagsgruppe Copyrighted material AOCMF Classification System AOCOIAC Software Solution regions or subregions corresponding to drawn lines are selected as fractured in accordance with rules and definitions e g location inside the transition zones of the mandible An important issue in the classification process is that when selecting one or more level 2 regions as fractured all other
4. fou are in taining mode saving any data is t posso 7 inio midtace Wi wi Sane AE r gaa MERTE Gar E 60 colar Pagen Dvtebese Help T Training W AO Surgery Aefereece Online Browse the AQ Foundation wet ra ttal to obtain turiher internation about the smecities Audig et al classification codes A window presents basic frequency statistics on the number of patients events and fractures per location level 1 system Upon selecting the filters the Statistic details window is updated and the list of related cases is presented within the bottom right window This list can be expended for all or any case to present the related event s and fracture code s which can be selected for direct opening within the patient and fracture tab respec tively Filtered cases and selected classification modules within the statistic details window can be deleted from the database only with appropriate rights or exported as binary file for sharing by other AOCOIAC users or as text delimited files for further data management and analyses An option for case pseudonymization is available at the time of export d AOCMF wn wecibks a04Cisetication 9 Crasic nidiece Menditle E Meat hecu Fi a Level bersi Leci Dertition Lewel 3 focused Skate Locate a AA WE ETS f h r 7 Ernai val i F F Modtk HM AO Foundation main DES 4 AO Foundation i maneiras Birhor Haree Eign Geeqono Sanches nre
5. S30 Buitrago T llez CH Audig L Strong B et al A comprehensive classification of mandibular fractures a preliminary agreement validation study Int J Oral Maxillofac Surg 2008 37 12 1080 1088 Bachli H Leiggener C Gawelin P et al Skull base and maxillofacial fractures two centre study with correlation of clinical findings with a comprehensive craniofacial classification system J Cranio maxillofac Surg 2009 37 6 305 311 Catapano J Fialkov JA Binhammer PA et al A new system for severity scoring of facial fractures development and validation J Craniofac Surg 2010 21 4 1098 1103 Ahmad Z Nouraei R Holmes S Towards a classification system for complex craniofacial fractures Br J Oral Maxillofac Surg 2012 50 6 490 494 Downloaded by Thieme Verlagsgruppe Copyrighted material
6. appendix available from the Journal Web site The whole series of cases are also made available in AOCOIAC binary format for direct import into the software www aocmf org classification such as presented in Fig 7 mandibular fracture and in Fig 8 midface zygomatic fracture Discussion The AOCOIAC is a unique software solution for classification and documentation of fractures using the new AO CMF classification system At the initiation of this development participating surgeons recognized the need for electronic software support for the systematic and standardized diag nosis process of complex facial injuries The precursor of Craniomaxillofacial Trauma and Reconstruction Vol 7 Suppl 1 2014 Downloaded by Thieme Verlagsgruppe Copyrighted material 120 AOCMF Classification System AOCOIAC Software Solution E SOO Melee Laurent Adige EAL AC Fasnia OCH Panam uth Help a Training Searching 4 Patents y History T Freche gl 0 Surgery Belerence Online Audig et al PS MWTR S7 008 CTA fy mendis Case Collection OLAV LIA 01 se OL ipen ine lit mode om local cor puter kb ARIAT EEEN f Hanm g Ow w ls PENNEN g Craan I Hya Fct Secured T a kus i Dreem Level J deare i Fie B Lewel lera Lewel 3 i amp I i 5 i Dirie Location 3 a a E J f A u SE 7 fa y iti i i a au p Ne P E THEY Bo z E a VEV E as T 4 yF 2 WUJ t a a f T
7. confined 0 Not fragmented l Fragmented Miner 2 Fragmented Major No bone hess d Bone loss defect Miot trectured Fractured Undetermined fw Confined Mat confined Morphology O Mot fragmented st l Fragmented Minor 2 Fragmented Major i No bone loss d Bone loss defect C Audig et al the cranium Similarly on the left column an illustration of both condylar processes is used for level 3 classification of condylar process subregions head neck and base Fracture classification may be implemented directly on the selected illustrations or using the side table on the right side of the screen window In the following we will focus essentially on the illustrations and refer to the side table as appropriate We consider the classification of a mandibular fracture first and then highlight some specificities of classifying fractures of the cranium It should be noted at this stage that it is most practical to classify fractures using AOCOIAC by viewing and assessing diagnostic images at the same time on a separate computer screen In AOCOIAC the panoramic view of the mandible has been selected Fig 3 To support the classification process the mouse pointer can be transformed into a pen by double click within the central window anywhere outside the illus tration and vice versa the pen can be used to draw the fracture line s as observed on the diagnostic images
8. heba y kenil Pilaa J y a Ezaa i Kii TEHE GHH L AJA LH WSA T LEF ee Figure 6 AOCOIAC software screen shots AOCOIAC AO comprehensive C History tab D Fracture tab After registering or opening a patient and one associated injury event two new tabs are made available namely the history and fractures tabs The history tab Fig 6C allows documentation of hospitalization and clinical examination data using text notes as well as a representative selection from the dia gnostic e g radiograph or computed tomography scans imaging The fractures tab Fig 6D allows access to the CMF classification module for any new classification by selecting the cranium on the presented skeleton The process of classification using the fracture tab is similar to that presented above using the training tab however it is possible then to save the generated diagnoses and codes in the case documentation database In addition the same injury may be classified by multiple users and all codes are saved The code generated last by any user is considered the valid code e g in the context of a fracture register In the patient tab an overview window provides the registered fracture codes and associated classifiers When opening a case that was already classified the fractures tab can open directly to the classification without presenting the skeleton This shortcut can be obtained by double clicking on the related icon within th
9. regions that are not explicitly categorized as fractured are not considered as fractured The same principle applies to the classification of level 3 subregions A double click with the mouse pointer on a region or subregion of interest opens up menu window tabulating level 2 and level 3 descriptors to specify the fracture in greater detail gt Fig 3 Using the menu windows regions that are difficult to analyze or evaluate e g due to lack or shortages in diagnostic imaging can be indicated as undetermined The classification process may be restricted to the level 1 or level 2 not taking the features of fracture morphology within level 3 into account If level 3 is applied it is reasonable that all affected regions are classified uniformly at this level to comply with a clear and concise layout Marking of a level 3 descriptor such as the fragmentation grade in a region or subregion however will automatically retroactivate the level 1 and level 2 classifications and can be used as a shortcut and timesaver in the coding process All level 3 classification features can be chosen interactive ly by use of the illustrations with one exception the direction of displacement for condylar process fractures this informa tion can only be recorded via the entry table on the right side of the screen window The user can switch the colored background regions in the illustration into black and white for better viewing of the Le Fort Il
10. S114 Tutorial Article The Comprehensive AOCMF Classification System Classification and Documentation within AOCOIAC Software Laurent Audig DVM PhD Carl Peter Cornelius MD DDS Christoph Kunz MD DDS Carlos H Buitrago T llez MD gt Joachim Prein MD DDS4 1 AO Clinical Investigation and Documentation AO Foundation D bendorf Switzerland 2 Research and Development Department Schulthess Clinic Zurich Switzerland 3 Department of Oral and Maxillofacial Surgery Ludwig Maximilians Universitat M nchen Germany 4 Clinic for Oral and Craniomaxillofacial Surgery University Hospital Basel Basel Switzerland gt Institute of Radiology Zofingen Hospital Zofingen Switzerland 6 Hightech Research Center for CMF Surgery University of Basel Basel Switzerland Address for correspondence Laurent Audig DVM PhD AO Clinical Investigation and Documentation AO Foundation Stettbachstrasse 6 CH 8600 D bendorf Switzerland e mail laurent audige aofoundation org Craniomaxillofac Trauma Reconstruction 2014 7 Suppl 1 114 S122 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 the location of the fractures within Keywords defined topographical regio
11. ded by Thieme Verlagsgruppe Copyrighted material 122 AOCMF Classification System AOCOIAC Software Solution prepared by AO Education publishing by Jecca Reichmuth and her colleagues The programming of AOCOIAC was performed by Dirk Sauter Ingenieurb ro Marschelke Reichenau Germany The authors are grateful to all surgeons as listed by Audig et al who participated in the successive classification sessions and provided their fruitful support in the development and validation of this fracture classifica tion system Note and Disclaimer An electronic copy of the AOCOIAC software and its user manuals can be obtained at the following Web site www aofoundation org aocoiac While the developers thrived to make this software as user friendly and useful as possible they cannot guarantee it is problem free and will work adequately on all computers The user manual should be read carefully before installation and use The AO Founda tion cannot take responsibility for any damages or incon veniences that may occur by using the available most current software version All case examples presented in this special issue of the Journal are made available in AOCOIAC binary format for direct import into the software and can be downloaded at the following Web site www aocmf org classification For use of the AOCOIAC software its manuals and all case examples the AO Foundation terms conditions and disclaimers apply https www aofou
12. e codes can be copied to the computer clipboard following double click of the mouse over them The related illustrations including drawn fracture lines can be copied or saved electro nically for use in publications and presentations Direct access to the AOCMF Surgery Reference portal gt Fig 5B at a remaining basic level of the classification is provided by selecting the icon AO Surg Ref on the right of the fracture code Craniomaxillofacial Trauma and Reconstruction Vol 7 Suppl 1 2014 S117 Downloaded by Thieme Verlagsgruppe Copyrighted material S118 AOCMF Classification System AOCOIAC Software Solution Documentation Database The log in button on the top right corner of the screen provides access to a database for password protected case documentation After log in two new tabs are made avail able namely the searching and patients tabs Fig 6 The patient tab Fig 6A is used to select individual records based on patient and injury event data or enter new records A window allows visualization of the fracture diagnosis and coding made by each classifier The searching tab Fig 6B allows displaying the number of documented cases which can be filtered according to several parameters Such parameters include for instance the institute classifier name patient age or gender event date or year participation into a clinical study or all or part of A a0 Come Pegen Uwtubuss Help T Training
13. e overview window of the patients tab E DLIA Seman LT a L a r e 22 A0 Foundation ss anp Paip by gt imie Seether praca E remm Derr TE io a l ba ri Pasar mh Wh Fer Bev MEET bs eet ioe rat ea io Fer al ig Ty ar zrs l on rr LERE Lur Pere ier fir ir r Genie Leas T al ee rir mrp oda oa Didi mnt z is n m Gar er y hele I aire lahira E beter WIRE Mai aw iia F b i ti CEE eei Biria STA SES jai mi TEN HHEH ph WHPR hers E LiT jasasrri 5 Serene hiha E mF wi T E Ti ahpa rr G sar bam TR EHHE eed IIH PHT CWA prh AEH jii CAITHE prh Erei chew un 12 CMT did rahi mn E T r mara oe e Li i ual a at B MOREL etc Lee ea MA Pct EH Reese Ha A0 CME i Tan o Derisa I Paie Sere Frertares Sa a i gt i i 7 rier i 1 7 Saas 9 5 H E PE w ES E Erari kemeni T Vere isl 7 r Et pe E i oe DOR ee paa aaj B injury automatic classifier software A Patient tab B Searching tab Case Examples All tutorial articles in this issue are illustrated by case examples that were formatted by means of the actual AOCOIAC CMF module version 4 0 Graphical representa tions of the classified cases are shown along with selected diagnosis images and descriptive text Additional cases typi cally seen in clinical practice ranging from simple nonfrag mented fracture confined in a single region to complex panfacial trauma were selected for presentation in an elec tronic
14. end of this paper Training versus Case Documentation The software interface is designed with a series of tabs projecting out from the left upper edge of the software window AOCOIAC starts with a training tab only with the depiction of two skeletons providing access to available 2 40 OOE Progam Databases Heip 1 Trainiag classification modules related to adult and pediatric systems respectively Fig 1 Each module is activated by clicking on the respective anatomical area such as the adult skull for the CMF classification system When accessing the CMF classifi cation module via the training tab the classification system can be tested and experienced with all its functionalities however it is not possible to save the classification data from clinical cases To save and document clinical cases the user must first log in to the built in database using the log in icon on the top right corner of the software window Each user must be registered within specific access rights by a designated user administrator The database can be installed locally on a computer hard drive or on a central server that can be accessed by working stations installed with AOCOIAC 2 AOCMF twos 14 Mee Tee Bae Ti lati it 1 posse n 9 i nin pH ki nomi Hee A PP ae BSS bi z 20 Camna 9 annm I Pa i Hal feted Level levai ieee Qentitien Level 3 fenmi zas Lianemon ae eed Pataca ME Aas z z Crama val Pola
15. ient and trauma event using the patient tab fracture classification is implemented via the fracture tab B Case images and clinical history are documented using the history tab B na Intel Pentium 4 2GHz a Minimal configuration AOCOIAC with local database 512 MB RAM client server installation XGA 1024 x 768 True Color 24 32 Bit 128 MB RAM Windows XP 32 bit with IE7 incl all updates or Free hard disk space 200 MB higher Windows Vista 32 64 bit Windows 7 32 64 bit TCP IP protocol support Setup requires administration Windows 8 32 64 bit rights Intel Core 2 Duo 2GHz c Note for Macintosh Linux Solaris users 2 GB RAM This software AO COIAC can be run using a x86 and Z XGA 1024 x 768 True Color 24 32 Bit 128 MB RAM AMD64 Intel64 virtualization software virtual ma Free hard disk space 5 GB in accordance with your chine such as using the freely available VirtualBox requirements www virtualbox org TCP IP protocol support Setup requires administration A Windows license is required rights b AOCOIAC for server database access client installation Acknowledgments Windows XP 32 bit with IE7 incl all updates Windows This CMF classification project was funded by the AO Vista 32 64 bit Windows 7 32 64 bit Windows 8 32 64 bit Foundation and its AOCMF Specialty Illustrations were Craniomaxillofacial Trauma and Reconstruction Vol 7 Suppl 1 2014 Downloa
16. n beser iinr Darie Gohan Hribprg Ricania Cimigos Cas Pager Comais Edward Bike I George Hashima A surgery Prente Mandible Cobre cetera on cee liia Shor Tcat Symphysis anid a Sergical apermaches marasympiysis An Treimanis aiapadicima j Sicifitional material used By AO Body Seti big nie r Congolese i i F iT TE e Anman E f i f F B m Miere mic alte AL BH a mandhi ENE Maad taal mamia fiain ULF Angle anid ramus y f 3 simple oi Ty omple i kj H f a Load ihin ait T at J reram loa Ej slei a i Teminologe B r WU Figure 5 Fracture classification coding and link to surgery reference A After completion of the classification the fracture code is presented within the bottom right screen window B Direct access to the AOCMF Surgery Reference portal is provided by selecting the icon on the right of the fracture code Craniomaxillofacial Trauma and Reconstruction Vol 7 Suppl 1 2014 Downloaded by Thieme Verlagsgruppe Copyrighted material AOCMF Classification System AOCOIAC Software Solution Audig et al F ODE Fenman Lim Age L AD Posen CM Peewee i fiee XOF lati ee o Emag Pe y e e a bead mo Parre a I hie a ii OO ie SET rm ere 5 Ajna rr aa m a o L r eer erie m ae oe a Sa eS aarm r T me iF nm 1 a a ae mgri PTF arrr a p pa a gt Peres a MLL ee eee Lr i E p E oe nasu oe al A aS 2 ae a a a aA a a mr mpa Desr e i
17. n relation to clinical findings Only few other authors previously presented option for comprehensive assessment of CMF fractures Catapano et al proposed a comprehensive method for panfacial fracture documentation and severity scaling In their system the fracture pattern is recorded by coding separately 41 anatomical regions according to one of the four categories O no fracture 1 single undisplaced or minimally lt 2 mm displaced fracture 2 single displaced gt 2 mm fracture or comminuted fracture and 3 bone loss A graph Craniomaxillofacial Trauma and Reconstruction Vol 7 Suppl 1 2014 ical scheme is used to support the diagnosis process however it was not to our knowledge transferred into a software solution Recently Ahmad et al proposed a new scoring system for craniofacial fractures that was incorporated into a database system to support documentation The AOCOIAC is the most advanced software solution available to classify and document fractures of the CMF skele ton It is a tool to initiate systematic documentation and evaluation of CMF fractures We encourage all CMF surgeons to adopt it and participate in its further development Technical Requirements AOCOIAC can be installed either locally for single users A or as server client installation for use in the clinical setting by multiple users B Downloaded by Thieme Verlagsgruppe Copyrighted material AOCMF Classification System AOCOIAC Softwa
18. ndation org Structure the ao foundation Pages legal aspx Craniomaxillofacial Trauma and Reconstruction Vol 7 Suppl 1 2014 Audig et al References 1 Ul Audig L Cornelius CP Di Ieva A Prein J CMF Classification Group The first AO classification system for fractures of the craniomax illofaxial skeleton rationale methodological background devel opmental process and objectives Craniomaxillofac Trauma Reconstr 2014 7 Suppl 1 S6 S14 M ller M Narzarian S The Comprehensive Classification of Frac tures of Long Bones Berlin Springer 1990 Slongo T Audig L The comprehensive AOCMF classification sys tem midface fractures level 3 tutorial J Orthop Trauma 2007 21 10 Suppl S135 S160 Cornelius CP Audig L Kunz C et al The comprehensive AOCMF classification system midface fractures level 3 tutorial Cranio maxillofac Trauma Reconstr 2014 7 Suppl 1 S68 S91 Kunz C Audig L Cornelius CP et al The comprehensive AOCMF classification system orbital fractures level 3 tutorial Cranio maxillofac Trauma Reconstr 2014 7 Suppl 1 S92 S102 Neff A Cornelius CP Rasse M et al The comprehensive AOCMF classification system condylar process fractures level 3 tutorial Craniomaxillofac Trauma Reconstr 2014 7 Suppl 1 S44 S58 Cornelius CP Audig L Kunz C et al The comprehensive AOCMF classification system mandible fractures level 2 tutorial Cra niomaxillofac Trauma Reconstr 2014 7 Suppl 1 S15
19. ndible and in the maxilla This CMF fracture classification system has been imple mented into AO comprehensive injury automatic classifier software AOCOIAC AOCOIAC is stand alone computer based software with user friendly interface to support frac ture diagnosis classification and coding via specific modules including the Miiller AO classification and AO pediatric classification systems for long bone fractures as well as the newly developed comprehensive CMF fracture classifica tion in its updated version 4 0 Copyright 2014 by AO Foundation DOI http dx doi org AOCMF 10 1055 s 0034 1389564 Clavadelerstrasse 8 ISSN 1943 3875 7270 Davos Switzerland Tel 41 44 200 24 20 Downloaded by Thieme Verlagsgruppe Copyrighted material AOCMF Classification System AOCOIAC Software Solution Audig et al di AO COIL E E _ s 42 AO Foundation a ij 1 i it i Dig indde ashen E E Hi A E o ela i me i j 3 a iog a is Lai 7 e A Tardy RFA Figure 1 AOCOIAC entry screen AOCOIAC AO comprehensive injury automatic classifier software While all the detailed features of the software are pre sented in a user manual this tutorial highlights its main features allowing fracture classification and clinical case documentation including selected imaging A series of case examples are documented and made available electronically for viewing and editing using this software see Note and Disclaimer at the
20. ns within each units level 3 relates to fracture morphology gt craniomaxillofacial in these regions regarding fragmentation displacement and bone defects as well as fractures the involvement of specific anatomical structures The resulting CMF classification gt classification system system has been implemented into AO comprehensive injury automatic classifier gt coding AOCOIAC software allowing for fracture classification as well as clinical documentation gt electronic of individual cases including a selected sample of diagnostic images This tutorial documentation highlights the main features of the software In addition a series of illustrative case system examples is made available electronically for viewing and editing The AOCMF Classification Group developed a hierarchical three level craniomaxillofacial CMF fracture classification system The level 1 and level 2 systems allows fracture location within defined regions and four major anatomical units including the mandible code 91 midface code 92 skull base code 93 and cranial vault code 94 The more detailed level 3 system considers refined fracture location according to the subregions specifically within the condylar process zygoma orbit and nose as well as morphology defined by fragmentation displacement and bone defects and the involvement of specific structures In addition the dental status and extend of bone atrophy can be described both in the ma
21. re Solution Audig et al 121 dB AE COURE Welcome Larena Adc MDL AE Fourhricn 614 Pagan mins Help D Treiniog G snarching Hi Paliani ines EY Frecteres PS TH S2 LLL CMA Appendix Case Collection ULUL 2012 WS ee QSen in Gait mode an local computer i Hodjas ates it I a A iF E Auto t a am Aidian o Oaa ahb amp erT i f Lewel l LeweliZ Lewd Hnd nauki j i 3 1 iF kul E a cor ore Hal Gha E F a ka TOC Y iin 3 lanih z Ae T a k e A TE H F se g 2 2 H ka Wgt g i ae 2 amp nf W j l i 7 A a E A Fouad Patent code OH PAD OTS Lah Comrtched bx Local compute huh i G COAL Webooene Lagrent Audige ULL A Foundaton CHI ns Poe Distanse Help i Tiaitikiag L Seamhing Patients J History Fracteres H ChMTR S2 111 CHITA Appar diy Cage Colection O1L 0D 2012 00A 0A Chen in edit meade on local ex mputer kb irae ii i 5 H mb E reret Lago Drim Tima Deanann Addad by u 1 Raia 1 B NT l Feetues dhagrces CPs Ce OO O Folow p7 Folow Upa Imaging 20 CT stans oblque lef trombolaieral view 3 caudolsieral view left bj craniofronial wew ch caudolronial wew d detai medio lateral wana inio Wet orbit g deak posters keral wew into ienporal hasa 7ygomahcosphencd inchar zone 1 coronal CT scans antaro poseno senes g n adel CT scare oj ssal CT scare af oristal ranson zone intemal obia butire
22. roids kr HiFi Figure 2 CMF classification module window in AOCOIAC AOCOIAC AO comprehensive injury automatic classifier software CMF craniomaxillofacial Craniomaxillofacial Trauma and Reconstruction Vol 7 Suppl 1 2014 S115 Downloaded by Thieme Verlagsgruppe Copyrighted material S116 AOCMF Classification System AOCOIAC Software Solution In the first part of this tutorial we will briefly present the functionality of the CMF classification module from the training tab then in the second part explain how case documentation can be implemented following user log in Craniomaxillofacial Classification Module The CMF classification module is organized and presented to facilitate fracture coding according to any of the three levels of the classification Fig 2 On the top left corner of the windows interface the skull is presented for level 1 classifi cation on the left column and top row respectively illus trations of the mandible and cranium give access to level 2 and level 3 classifications By clicking the mouse pointer on the desired illustrative view a corresponding larger illustra tion is presented in the central window with delimitations of level 2 regions or level 3 subregions depending on the selected view On the top row a panoramic illustration of the zygomas orbits and nose delimits level 3 subregions for a Freinke Not fractured e Fractured Undetermined iw Confined Not
23. ss eft u at paramedian Orbe k vi midde orbit kt w lateral orbit interior ortital Tesir xh at laial lateral anirai pees yi at liera orbital rim left z Gomeri description Poster mecdealy dspeed mult piece cygoma fracture ef associsted vath merr otta wall fracture and muiiragmentation along the zygomacc maollary crest and face antral wall Details Denstion FO unelected ful upper prev Genthon pie and posiequry Rien god left unatfected Fragrreniation sypia razume of myganiatic body with a seriti ular fracture line running parallel to the intersdateral ortiial rien gisa fracture fines along the upper zygomebeco sphened and zygomatcotronial suture ine muthfragmentabon in the lateral portion of the infenor orbital wal invoking the inferior orttal fissure and the l ser and of the zyQomatco sphencad suture line muitifragnnentation ef the antral wall Pretreatment gt Tregieent Follew Up I angie fracture of iniaa nim angia fraclure Separating Zygqomalic arch iran 2ygomale body near the Sygomaioo lemeaal aeui second single suture ine midway in zygomatic arch Depage eia an pe caplacement of the Zygorma decreasing orbilal voli Gaal impachon a rye bendy Iragin intemal orbis imrohverment of fhe anterior and madorbital sachon left menor beral wal postenor legde intact intemal orbital butiness ntact B Remy Patent Combe CH MAT CMT R S ean 1h Lock e hPa Figure8 Midface zygomatic fracture documentation A After registering pat
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