1/
My fellows complained they hate memorizing classifications, like LeFort. I thought, “There must be a better way—maybe understanding instead of memorizing.”
2/ To understand LeFort, you need to understand facial buttresses.
These are not true anatomic structures but a way of understanding facial structure.
Facial bones support facial structures like a table supports food, with legs (vertical buttresses) and table top (horizontal)
3/ In the face, the two main structures the buttresses are supporting are the orbits and the alveolar ridges of the maxilla and mandible supporting the teeth
4/ The buttresses not only support against gravity, but also against the force of mastication, which sends force from the mandible all the way through the maxilla to the skullbase
5/ The buttresses are the table tops and table legs resisting these forces
6/ Horizontal buttresses—there is a tabletop underlying each of the structures that need support in the face: the orbit, maxillary teeth, mandibular teeth, and mandible
7/
Here is the illustration of the horizontal buttresses and their official anatomic names. However, the names aren’t as important as remembering where they are—and you can do that by remembering that each important structure has a tabletop right below it.
8/ Vertical buttresses—these are the support posts. And they are arranged just how you would arrange them if you were building a house. Two in front, two in back.
9/ Here is the illustration of the vertical buttresses and their official anatomic names. But again, names aren’t important—function is!
10/
Vertical buttresses act as suspension wires for the maxilla, suspending it from the skullbase. They are what keep your face on!
11/
LeFort fx is when your face (maxilla) gets take off! To take it off, we have to cut the suspension wires--all three (posterior, medial, and lateral). The posterior buttress (pterygoid plate) is always cut. That is why pterygoid fx's are the signature of LeFort injuries
12/
Where we cut the other two buttresses determines which LeFort fx we get.
And now, you can just think of cutting the suspension wire to the maxilla, and never have to memorize the LeFort classification again!
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If you don’t know the time of stroke onset, are you able to deduce it from imaging?
Here’s a thread to help you date a stroke on MRI!
2/Strokes evolve, or grow old, the same way people evolve or grow old.
The appearance of stroke on imaging mirrors the life stages of a person—you just have to change days for a stroke into years for a person
So 15 day old stroke has features of a 15 year old person, etc.
3/Initially (less than 4-6 hrs), the only finding is restriction (brightness) on diffusion imaging (DWI).
You can remember this bc in the first few months, a baby does nothing but be swaddled or restricted. So early/newly born stroke is like a baby, only restricted
1/”I LOVE spinal cord syndromes!” is a phrase that has NEVER, EVER been said by anyone.
Do you become paralyzed when you see cord signal abnormality?
Never fear—here is a thread on all the incomplete spinal cord syndromes to get you moving again!
2/Spinal cord anatomy can be complex. On imaging, we can see the ant & post nerve roots. We can also see the gray & white matter. Hidden w/in the white matter, however, are numerous efferent & afferent tracts—enough to make your head spin.
3/Lucky for you, for the incomplete cord syndromes, all you need to know is gray matter & 3 main tracts. Anterolaterally, spinothalamic tract (pain & temp). Posteriorly, dorsal columns (vibration, proprioception, & light touch), & next to it, corticospinal tracts—providing motor
1/Do you get a Broca’s aphasia trying remember the location of Broca's area?
Does trying to remember inferior frontal gyrus anatomy leave you speechless?
Don't be at a loss for words when it comes to Broca's area
Here’s a 🧵to help you remember the anatomy of this key region!
2/Anatomy of the inferior frontal gyrus (IFG) is best seen on the sagittal images, where it looks like the McDonald’s arches.
So, to find this area on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, i’m lovin it.
3/Inferior frontal gyrus also looks like a sideways 3, if you prefer. This 3 is helpful bc the inferior frontal gyrus has 3 parts—called pars
1/Need help reading spine imaging? I’ve got your back!
It’s as easy as ABC!
A thread about an easy mnemonic you can use on every single spine study you see to increase your speed & make sure you never miss a thing!
2/A is for alignment
Look for: (1) Unstable injuries
(2) Malalignment that causes early degenerative change. Abnormal motion causes spinal elements to abnormally move against each other, like grinding teeth wears down teeth—this wears down the spine
3/B is for bones.
On CT, the most important thing to look for w/bones is fractures. You may see focal bony lesions, but you may not
On MR, it is the opposite—you can see marrow lesions easily but you may or may not see edema associated w/fractures if the fracture is subtle