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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1/ I always say, "Anyone can see the bright spot on diffusion images—what sets you apart is if you can tell them why it’s there!”
If you don't why a stroke happened, you can't prevent the next one!
Can YOU tell a stroke’s etiology from an MRI?
Here’s a thread to show you how!
2/First a review of the vascular territories.
I think the vascular territories look a butterfly—w/the ACA as the head/body, PCA as the butt/tail, and MCA territories spreading out like a butterfly wings.
3/Of course, it’s more complicated than that.
Medially, there are also small vessel territories—the lenticulostriates & anterior choroidal.
I think they look like little legs, coming out from between the ACA body & PCA tail.
1/Asking “How old are you?” can be dicey—both in real life & on MRI!
Do you know how to tell the age of blood on MRI?
Here’s a thread on how to date blood on MRI!
After reading this, when you see a hemorrhage, your guess on its age will always be in the right vein!
2/If you ask someone how to date blood on MRI, they’ll spit out a crazy mnemonic about babies that tells you what signal blood should be on T1 & T2 imaging by age.
But mnemonics are crutch—they help you memorize, but not understand
If you understand, you don’t need to memorize
3/If you look at the mnemonic, you will notice one thing—the T1 signal is all you need to tell if blood is acute, subacute or chronic.
T2 signal will tell if it is early or late in each of those time periods—but that type of detail isn’t needed in real life
@TheAJNR 2/Since the prehistoric days of medicine (1979!), we knew that some brain tumor patients treated w/radiation (XRT) initially declined, but then get better.
Today, we see this on imaging, where it looks worse early, but then gets better.
Now we call this pseudoprogression.
@TheAJNR 3/Why does this happen?
XRT induces a lot of inflammatory changes—from initiating the complement cascade to opening the blood brain barrier (BBB)
It’s these inflammatory changes that make the imaging look worse.