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

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More from @teachplaygrub

Jul 2
1/The medulla is anything but DULL!

Does seeing an infarct in the medulla cause your heart to skip a beat?

Does medullary anatomy send you into respiratory arrest?

Never fear, here is a thread on the major medullary syndromes! Image
2/The medulla is like a toll road.

Everything going down into the cord must pass through the medulla & everything from the cord going back up to the brain must too.

That’s a lot of tracts for a very small territory. Luckily you don’t need to know every tract Image
3/Medulla has 4 main vascular territories, spread out like a fan: anteromedial, anterolateral, lateral, and posterior.

You don’t need to remember their names, just the territory they cover—and I’ll show you how Image
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Jun 30
1/Time is brain! But what time is it?

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! Image
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. Image
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 Image
Read 10 tweets
Jun 27
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! Image
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. Image
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 Image
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Jun 23
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! Image
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. Image
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 Image
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Jun 19
1/Feeling intoxicated trying to remember all the findings in alcohol use disorder?!

Here’s something to put you in high spirits!

This month’s @Radiographics has the important neuroimaging findings alcohol use disorder!



@cookyscan1 @RadG_editor #RGphx pubs.rsna.org/doi/10.1148/rg…Image
2/There’s an easy rhyme to help you remember the important neuroimaging findings of alcohol use disorder

“Basal ganglia is white...”

Get intrinsic T1 shortening in the BG that makes it look white as a ghost! Image
3/Next “...Cortex is bright”

Acute hyperammonemic encephalopathy cause cortical restricted diffusion, especially the insula, so that it looks as bright as a light bulb! Image
Read 8 tweets
Jun 9
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! Image
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 Image
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 Image
Read 11 tweets

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