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Overview of the Skull

Overview of the Skull

The cranium (skull) is the skeletal structure of the head that supports the face and protects the brain. It is subdivided into the facial bones and the brain case, or cranial vault. The facial bones underlie the facial structures, form the nasal cavity, enclose the eyeballs, and support the teeth of the upper and lower jaws.
The cranial vault surrounds and protects the brain and houses the middle and inner ear structures. This cavity is bounded superiorly by the rounded top of the skull, which...

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Related Experiment Video

Updated: May 5, 2026

A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible

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Published on: January 28, 2020

The Birmingham mandible and midface rules: final data analysis.

Ross O C Elledge¹, Sarafina Vatharkar¹, David McNulty¹

¹University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

The British Journal of Oral & Maxillofacial Surgery

|December 12, 2025

Summary

This summary is machine-generated.

The Birmingham mandible and midface (BruMM) rules can help emergency medicine clinicians decide when to use plain film radiography for suspected facial fractures. Applying these rules could reduce unnecessary X-rays and save costs.

Keywords:

BruMM Clinical predictor Facial trauma Mandible fracture Maxillofacial radiology Predictor rule Zygomatic fracture

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Area of Science:

Emergency Medicine
Radiology
Clinical Decision Support

Background:

Heuristics and predictor rules are vital in emergency medicine due to extensive knowledge requirements.
The Birmingham mandible and midface (BruMM) rules were developed to aid decision-making for facial fracture radiography.

Purpose of the Study:

To evaluate the effectiveness of the BruMM rules in a real-world clinical setting.
To refine the BruMM rules for diagnosing mandibular and zygomatic fractures using plain film radiography.

Main Methods:

Frontline clinicians applied BruMM rules to suspected mandibular/zygomatic fractures.
Radiographs were reviewed for fracture presence.
Discriminant analysis using LASSO regression and a forward stepwise Jaccard procedure was performed.

Main Results:

A composite BruMM-rules score with 3 mandibular and 6 zygomatic predictors was developed.
Maximal sensitivity was 96.4% and specificity was 56.5%.
Implementation could avoid 43.4% of plain film radiograph studies, saving £8,356.86-£15,440.76 annually.

Conclusions:

The refined BruMM rules offer a sensitive tool for diagnosing facial fractures.
The BruMM rules can optimize radiography use, leading to significant cost savings.