Abstract
A comprehensive classification of midfacial/craniofacial fractures, based on two-
and three-dimensional computed tomography (2D and 3D-CT) is presented.
We performed a postmortem analysis of 24 patients who had died from trauma with signs
of craniofacial fractures, based on 2D and 3D-CT studies with pathoanatomical findings.
In addition, CT findings for 100 patients with craniofacial injuries requiring an
emergency CT were correlated with surgical findings and follow-up results. On the
basis of the analysis of a total of 377 fractures a classification system is proposed.
The system is based on the use of the AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association
for the Study of Internal Fixation) scheme, defining three types (A, B, C), three
groups within each type (e.g. A1, A2, A3) and three subgroups within each group (e.g.
A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest). The
craniofacial region is divided into three units: the lower midface (I), the upper
midface (II) and the craniobasal-facial unit (III). Lateral and central fractures
are also distinguished. Type A fractures are non-displaced fractures, type B are displaced
fractures and type C are complex/defect fractures. Groups A1, B1 and C1 comprise fractures
of an isolated unit; groups A2, B2 and C2, combined fractures without involvement
of the skull base; and groups A3, B3 and C3 are those combined fractures with involvement
of the skull base. A correlation between the severity of the fracture and (i) the
number of posttraumatic functional limitations (Spearman rank test, correlation coefficient
r=0.42), (ii) the need for bone grafting or dural plastic (r=0.39) and (iii) facial asymmetry (r=0.37), was observed. The proposed classification system allows standardised documentation
of midfacial and craniofacial fractures, including those not precisely defined by
the Le Fort classification scheme.
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Article info
Publication history
Accepted:
May 23,
2002
Identification
Copyright
© 2002 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.
