MedRophine Science

2022-05-17 18:21:00 Normal MRI Anatomy باز کردن / نظر دهید

2022-05-17 18:20:22 Since we all encounter with lateral neck X-ray in our daily practice , it's very important that aside from bony structures we pay special attention to the soft tissue of the neck. That's why I attached another labeled lateral neck that perfectly demonstrates soft-tissue in details. باز کردن / نظر دهید

2022-05-17 18:19:43 The palate (also known as the ‘roof of the mouth’), forms a division between the nasal and oral cavities. It is separated into two distinct parts:

Hard palate – comprised of bone. It is immobile. There are three main foramina/canals in the hard palate:

Incisive canal – located in the anterior midline, transmits the nasopalatine nerve.

Greater palatine foramen – located medial to the third molar tooth, transmits the greater palatine nerve and vessels

Lesser palatine foramina – located in the pyramidal process of the palatine bone, transmits the lesser palatine nerve.

Soft palate – comprised of muscle fibres covered by a mucous membrane. There are five muscles which give the actions of the soft palate. They are all innervated by the pharyngeal branch of the vagus nerve (CN X) – apart from Tensor veli palatini – which is innervated by the medial pterygoid nerve (a branch of CN V3)
It can be elevated to close the pharyngeal isthmus during swallowing – باز کردن / نظر دهید

2022-05-17 18:18:31 Waldeyer’s ring:

Tonsils are collections of lymphatic tissue located within the pharynx. They collectively form a ringed arrangement, known as Waldeyer’s ring:

Pharyngeal tonsil
Tubal tonsils (x2)
Palatine tonsils (x2)
Lingual tonsil
The tonsils are classified as mucosa-associated lymphoid tissue (MALT), and therefore contain T cells, B cells and macrophages. They have an important role in fighting infection – the first line of defence against pathogens entering through the nasopharynx or oropharynx.

The pharyngeal tonsil refers to a collection of lymphoid tissue within the mucosa of the roof of the nasopharynx. When enlarged, the pharyngeal tonsil is also known as the adenoids.
It is located in the midline of the nasopharynx, and forms the superior aspect of Waldeyer’s ring باز کردن / نظر دهید

2022-05-16 20:37:09 Basic structures of normal pharynx باز کردن / نظر دهید

2022-05-16 20:36:16 The term “esophagram” is slowly replacing the ambiguous term “barium swallow.” Note that an esophagram, which is designed to evaluate the pharyngeal and esophageal mucosa, is distinct from a “modified barium swallow,” which evaluates laryngotracheal aspiration and is usually performed in conjunction with a speech pathologist. At some institutions, an esophagram includes a complete evaluation of the pharynx, but at other institutions, a “cervical esophagram,” “pharyngoesophagram,” or “pharyngography” must be specifically requested.

Note that the nasopharynx is not evaluated with fluoroscopic techniques; cross-sectional imaging is required.

Pharyngoesophagram

A complete esophagram has three phases: full-column (single contrast), air-contrast (double contrast), and mucosal relief. To obtain full-column images, the patient is given a thin suspension of barium by mouth. The pharynx is best imaged in the standing position, with rapid cineradiography (four to six images per second) in several projections . باز کردن / نظر دهید

2022-05-16 20:35:23 Divisions

The pharynx is arbitrarily divided into three parts—the nasopharynx (epipharynx), oropharynx (mesopharynx), and laryngopharynx (hypopharynx).

The nasopharynx is primarily a respiratory tract structure continuous anteriorly with the nasal cavity. The nasopharynx is separated inferiorly from the oropharynx by the soft palate.

The oropharynx and hypopharynx are the divisions of the pharynx that participate in swallowing. The oral cavity opens into the oropharynx at the palatoglossal isthmusThe oropharynx lies posterior to the oral cavity.

The three divisions of the pharynx are arbitrary because the soft palate and hyoid bone change position with phonation, swallowing, and respiration. Therefore, a better dividing line between the oropharynx and hypopharynx is the pharyngoepiglottic fold , a mucosal fold overlying the stylopharyngeal muscle. The base of the tongue forms the lower anterior wall of the oropharynx. باز کردن / نظر دهید

2022-05-15 22:12:32 3. Ability to work anterior/posteriorly simultaneously. I could not remove the L3-4 retained cage through the pronelateral incision (it was on right side) so I identified it using nav posteriorly through my PCO. I was able to posteriorly grab it with a pituitary and push into my pronelateral incision.

4. 27 degree restoration at L5-S1
5. When I was working laterally, my PA was working posteriorly and literally yelled “I can see the Light!!” It was my head light

6. Patient is doing great at 4 weeks PO minus a 4/5 right foot drop that I am a bit baffled by.

WARNING: When Irrigating posteriorly in a pronelateral case, be aware of irrigation coming out the lateral approach incision onto your feet.

Sorry so long!! باز کردن / نظر دهید

2022-05-15 22:10:40 62 year old with iatrogenic flat back. 51 degree mismatch. Retained “stacks” TLIF cage at L3-4

Treated with:
1. L5-S1 ALIF with expandable cage (catalyft) allowing 27 degree correction at L5-S1
3. T10-S2 robotic Mazor screw placement overlapped with preop UNiD planning/patient specific rods
4. L2-3/L3-4 navigated PRONELATERAL with Anterolign (first time using. Loved it) AND simultaneous L3-4 PCO with TLIF cage removal

So many cool things about this case!!
1. My UNiD engineer (Caylie) and I worked on this plan weeks in advance. We could get the GAP score down to 0-1 with L5 PSO AND three TLIFs but I felt that was to much surgery for this lady AND I had a retained interbody I had to remove from L3-L4. So we settled for the above plan accepting a GAP of 5. Amazing how we can now simulate the plans and get patient specific rods to guide us.
2. Fully navigated lateral grafts!! باز کردن / نظر دهید

2022-05-14 14:48:42 Age 11 years
PMH: Aplastic anemia discovered since 2 years
For blood and platelets transmission.
Waiting for bone marrow donor

What can I do for left eye ? باز کردن / نظر دهید