Lea Alhilali, MD Profile picture
Jun 8, 2022 14 tweets 7 min read Read on X
1/Mike Tyson once said, “Everyone has a plan until they get punched.”
In honor of all the great hooks and crosses—here is a #tweetorial about mandibular fxs! #FOAMed #medtwitter #Meded #neurorad #HNrad #FOAMrad #Medstudenttwitter @MedTweetorials Image
2/A key concept in these fxs is dental occlusion. The jaw is meant to chew. To crush food, teeth need to come as close together as possible—occlusion. Each tooth needs to meet up with its counterpart that fits with it, so no room is left for food—and food will be crushed. Image
3/Occlusion can be lost w/a fx. The importance of dental occlusion makes mandibular fxs different from other fxs. Usually, we want to fix a bone so that it lines up again. But for the mandible, we want to fix it so the TEETH line up again—so chewing will work. Image
4/Another important concept is multiplicity. It used to be taught that the mandible was a ring w/the skullbase—& you can’t break a ring in one place, so every mandible fx had to have a 2nd one. But this is only true ~50% of time—but it is still worth it to look for the 2nd fx. Image
5/Because of the shape of the mandible and the typical forces applied to it, mandibular fractures usually occur at the same few locations. But the names of these fxs are not always intuitive—at least not without a tweetorial to help explain them! 😉 Image
6/Well, perhaps I lied a little. The most common fx does have an intuitive name. An angle fx starts at…wait for it…the angle and extends into socket of the 3rd molar. If you can’t remember an angle fx starts at the mandibular angle, then not even this tweetorial can help you! Image
7/A subcondylar fracture starts from the notch between the condyle and coronoid process, called the sigmoid notch and extends into the posterior ramus. Don’t call this a ramus fx bc a ramus fx goes straight horizontally through the ramus! Image
8/Here are examples of subcondylar fxs. A key finding in subcondylar fxs is that it separates the condyle from the rest of the mandible. It can be difficult to see the fx running through the sigmoid notch & ramus on 2D images—3D images can be helpful to see the fx anatomy. Image
9/I remember subcondylar fxs bc they separate the condyle from the rest of the mandible. If you isolate someone, you make them feel SUBpar—so SUBcondylar fxs make the condyle feel subpar bc they separate it from the rest of the mandible! Image
10/Condylar head/neck fxs are easy to remember—they are through, well, the condylar head or neck. These are fx/dislocations. Pterygoid muscles attach to the head & pull medially. So when the head is no longer attached to the mandible, pterygoids are unopposed & pull it medially. Image
11/So if you ever see a condylar head displaced medially, you know it is a condylar head or neck fracture bc this is where the pterygoids are unopposed and pull medially! Image
12/Body fxs are through the body of the mandible and are named for the tooth socket that they involve. So you would say “A mandibular body fx through the FILL IN THE BLANK TOOTH socket.” Image
13/Body fxs through the canine are given the special name “parasymphaseal” or “mental” fx bc they are near the mental foramen where the inferior alveolar nerve exits. Menton means “chin” in French, so if they are a body fx anteriorly near the chin, they are “mental” fxs Image
14/So now you know your mandibular fractures & you have a plan even when the patient gets punched! Image

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Lea Alhilali, MD

Lea Alhilali, MD Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @teachplaygrub

Apr 28
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 so that the next time you see a hemorrhage, your guess on when it happened will always be in the right vein! Image
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 memorizeImage
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

So let’s look at T1Image
Read 20 tweets
Apr 25
1/Radiologist not answering the phone?

Just want a quick read on that stat head CT?

Here's a little help on how to do it yourself w/a thread on how to read a head CT! Image
2/In bread & butter neuroimaging—CT is the bread—maybe a little bland, not super exciting—but necessary & you can get a lot of nutrition out of it

MRI is like the butter—everyone loves it, it makes everything better, & it packs a lot of calories. Today, we start w/the bread! Image
3/The most important thing to look for on a head CT is blood.

Blood is Bright on a head CT—both start w/B.

Blood is bright bc for all it’s Nobel prizes, all CT is is a density measurement—and blood is denser (thicker) than water & denser things are brighter on CT Image
Read 20 tweets
Apr 23
1/Time to FESS up! Do you understand functional endoscopic sinus surgery (FESS)?

If you read sinus CTs, you better know what the surgeon is doing or you won’t know what you’re doing!

Here’s a thread to make sure you always make the important findings! Image
2/The first step is to insert the endoscope into the nasal cavity.

The first two structures encountered are the nasal septum and the inferior turbinate. Image
3/So on every sinus CT you read, the first question is whether there is enough room to insert the scope.

Will it go in smoothly or will it be a tight fit? Image
Read 19 tweets
Apr 21
1/Ready for a throw down?

MMA fights get a lot of attention, but MMA (middle meningeal art) & dural blood supply doesn’t get the attention it deserves.

A thread on dural vascular anatomy! Image
2/Everyone knows about the blood supply to the brain.

Circle of Willis anatomy is king and loved by everyone, while the vascular anatomy of the blood supply to the dura is the poor, wicked step child of vascular anatomy that is often forgotten Image
3/But dural vascular anatomy & supply are important, especially now that MMA embolizations are commonly for chronic recurrent subdurals.

It also important for understanding dural arteriovenous fistulas as well. Image
Read 17 tweets
Apr 16
1/ Need a global perspective on dementia?

Do you know the global cortical atrophy (GCA) score for evaluating dementia patients—or are you still gestalting volume loss???

Don’t estimate when you can calculate!

Here’s a thread of what you need to know about the GCA score! Image
2/The global cortical atrophy score calculates cortical volume loss on a scale of 0-3 in 13 different regions & ventricular dilatation

Gyri shrink down w/atrophy, the same way your cheeks shrink down with aging! Image
3/Gyri look like lips with around a mouth of sulcal space.

Without volume loss, the gyri look like big fat pursed model lips

But w/volume loss they open up like the scream w/thinning of the lips Image
Read 9 tweets
Apr 14
1/Wish that your knowledge of autoimmune encephalitis was automatic?

Do you feel in limbo about limbic encephalitis?

Do you know the patterns?

Read on for what you need to know in this month's @RadioGraphics review!



@cookyscan1 @RadG_Editor doi.org/10.1148/rg.240…Image
@RadioGraphics @cookyscan1 @RadG_Editor 2/Two pearls:
(1) Most common pattern is limbic encephalitis
(2) Small cell can cause any autoimmune pattern.

You can remember the causes by the demographic:
Young man: testicular
Older: Small cell
Woman with psychiatric symptoms (limbic): breast Image
@RadioGraphics @cookyscan1 @RadG_Editor 3/Limbic encephalitis is the most common pattern

But it has many, many different causes

Remember--limbic involvement is shaped like a question mark!

So for limbic encephalitis, the cause remains a question bc differential is so broad

Must question & clinically correlate! Image
Read 8 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(