Restorative Art - Week Eight

when lip contact cannot be maintained

1. cut frenulums 2. dislocate lower jaw 3. straight pin impalement into gums between teeth 4. sutures (final resort, as line of closure is distorted and lips must be waxed)

cranial post-mortem treatment

DURING EMBALMING- the scalp must not be permitted to remain everted downward over the face unless it is rolled over a cylinder of cotton (otherwise a transverse dark brown line will appear) AFTER EMBALMING- the torn vessels within the skull are ligated

overfilling similar structures on opposite sides of face

MAJOR fault of hypodermic tissue building

support of the teeth

absence of teeth affects the surface contour of the mouth -bridge is inserted behind the lips before embalming to lend support to surface structures

upper eyelid

abuts against the lower third of the eyesocket

cement

affords the strongest bond and is usually employed for the application of long, dense, or more extensive hair restoration

cotton foundation

after any gap between the teeth or gums are plugged with cotton, two pieces of cotton is prepared as wide as the line of closure and slightly less than the height of both gums

eyelids are checked for preservation

after embalming eyes.... -saturated cotton is removed and...

3/16ths of an inch above the eyelash

an incision made across the upper eyelids made upon good conditioned eyelids

removal of fat from behind the eyeball

another method of reduction for swelling of eye

hair restoration of the sideburn/temple

anterior margin of the sideburn is vertical -above this the temporal hair moves slightly forward to create a sharp angle with the recessive part of the hairline (on an adult male) -on a male, the hair of the sideburn is normally vertical from the level of the zygomatic arch to that of the top of the ear

strong solution of embalming chemical

applied to eccymosis in order not to aggravate -during embalming, external pressure is applied to control swelling -after embalming, small incisions may be made on the under surface of the upper eyelids -dry cotton is applied to absorb liquids

cavity fluid compress

applied to the exposed derma

nail restoration

artificial fingernails -broken or damaged fingernails may be covered with artificial nails

liquid colloid (plus a solvent)

available form mortuary suppliers; it is currently acknowledged as a superior tissue filler

opthalmic artery is ligated/optic foramen is plugged

before embalming eyes... -fresh cotton is substituted -face is heavily creamed

fractures (simple)

broken bones do not pierce the skin -sometimes is not known until leakage from the ears and nose are observed during the embalming -cotton is packed into opening

exophyhalmic goiter

bugged out eyes -no remedy is used, leave as is

protruding eyes

caused by abnormal protrusions of the eyeballs -not as common as eyelid distentions

sunken temples

concavity lies between the lateral rim of the eyesocket and the sideburn -hidden points of entry are: eyebrows sideburns hair of temple behind the top of the ear behind the anterior part of the helix

sunken tissue of the hands

correction of the hollows may be achieved by injecting tissue builder from the points between the knuckles -points of entry must be deep enough to be hidden from view

method of attaching hair

depends upon the length, the quantity, the underlying surfaces, and the area involved -may be attached with wax, liquid cement, sutures, embedding, melted wax

desiccated mucous membranes

devoid of moisture and appear leatherized -can be restored only by modeling artificial lips

prior bleaching

effective for blood discolorations only

sunken cheeks

emaciation in the cheek involves a somewhat triangular area -two opposite points of entry are usually necessary -hidden points of entry include: nostril corner of mouth behind the lobe of the ear behind the tragus of the ear behind the upper part of the jaw line

severed area or limb

embalmed separately -the leaking vessels are permanently ligated -hypodermic injection may be necessary to supplement the embalming process -a hole is drilled through the end of the bone to be connected -a strong, flexible wire is threaded through the holes and twisted off slightly

embedding

employed chiefly for restoration of stray or straggled hairs -two or three hairs are inserted in the skin with a needle -half of the "eye" of a sewing needle is removed to make an embedding instrument, the remaining part of the "eye" becomes the receptacle for the hairs

red hair

extensive range from the very deep extremity of brown-red to the lightest blond

sunken eyeball

eyelids may be projected with circular pads of cotton placed upon the eyeball -natural curvature of the eyelids may be distorted when a large amount of cotton is placed -an eyecap upon the cotton may provide the solution

swollen eyelids

from edema or embalming -can be reduced by external pressure or aspiration during embalming -after embalming, cavity fluid compresses surgical reduction of the fat of the orbit or the heat of an electric spatula may be used

opaque cosmetics

generalized discolorations must be masked with...

perforated eyecap

has holding qualities on dehydrated eyelids -cement on the surface can implement the process

blonde

has small quantities of light brown and straw (yellow) hairs

white hair

has tiny traces of brown, yellow, and gray

points of entry

hidden point selected to insert needle -puncture turns dark when exposed to air

artificial eyelids built on adhesive tape

if eyelids are in poor condition, they may be removed and replaced with...

distortion by superficial pressure

if the deceased has lain face down for some time before embalming the nose may be bent out of position

sunken supraorbital area

injecting tissue filler downward through several punctures made in the eyebrows -fingers are lightly placed upon the eyelid so the filler can be contained in the area without flowing into the eyelid

dusting the calvarium with hardening compound before returning scalp to position

leakage from small scalp vessels can be controlled by...

searing with the electric spatula or phenol

leakage from the edges of the incised scalp may be controlled by...

suturing

limited use for hair restoration -because of appearance, used only at areas which will not be visible -primarily when the head of a female is to be covered with a cap or a scarf

sunken submandibular area

long needle is necessary to restore this area since the hidden point of entry is located behind the angle of the jaw -needle must be long enough to reach the midline below the chin

expression changes

lower jaw may be drawn too high when aged persons have no teeth -sulci appear as part of the line of closure

arterial embalming

may arrest the progress of putrefaction

opaque liquid cosmetic "undercoat"

may be applied to maximize the amount of opaque (cream) cosmetics needed to hide discoloration

liquid sealer

may be applied to obtain a strong bond and help hold the calvarium in place and modify any flaw so that it will bot be noticeable through the replaced scalp

localized discolorations

may be bleached with a cotton compress before they are cosmetically treated(such as black eyes or contusions)

swelling

may be caused by embalming, decomposition, injury, or a specific pathological condition -correction depends upon the locality of the area and the causative factor

bulging eyes

may be caused by tissue gas in the cranial vault -cribiform plate may be punctured in order to correct this condition

simple fracture of nasal bone

may be corrected by forcing them back to position with an instrument entered into the nostrils

massage cream

may be injected subcutaneously as a filler, a very soft cream is desirable

artificial hair

may be made of nylon or wool

hair for large restoration

may be obtained from stores, wig makers, and beauty shop suppliers

sandpaper

may be placed beneath the lips

sunken eyes

may be projected by injecting tissue builder behind eyeball -needle is inserted between lips of inner canthus at the medial end of eyelids -when needle reaches the depth of the eyesocket (*1.5 inches deep*) it is cached in fat

edematous swelling

may be punctured or aspirated to release the collection of liquids

swollen region

may be reduced by external pressure, lancing, or aspiration -pressure between the fingers or surgical reduction

discolored nails

may be removed by embalming -after embalming, the discoloration may be lifted from the nail bed by inserting a fingernail file

sunken lips

may be restored by hypodermic tissue building after embalming (mouth region)

depression bone

may be retracted by making a small incision, drilling a small hole through the bone and inserting an oversized screw upon which tension may be exerted

minor dislocation of lower jaw

may be set before embalming by inserting fingers in the mouth and pressing them back into position

worm suture

may be substituted for the baseball suture -very good for a bald head

distorted nose

may be twisted from its normal alignment by cancer of the cheek, by superficial pressure, or by a fracture

camel hair brushes

may be used for very short hair restorations, but this proves expensive and the hair must be colored

dehydrated inner canthus

may cause an opening at the inner corner of the eyelids, even when the eyelids are closed -cementing is seldom successful and the practicality of suturing is questionable -a small pellet of colored wax may be employed to fill the opening

swollen orbital pouch

may have a tendency to swell during embalming -external pressure ma be applied at this time -condition persists after embalming hypodermic injection of a constricting fluid and subsequent removal minutes later

middle aged person

may have dark brown hair which has gray threads

humectant

moistening fluid, may be added to the embalming chemical as an internal tissue builder

mouth former

mortuary suppliers make available several types of mouth formers, some made of metal, plastic -people without teeth

wiring

most effective method of holding the calvarium in position so it does not shift

solvent

must be used to clean hypodermic syringe and needle

buck teeth

must not be extracted without permission from a person in authority -if exposed, painted with clear nail polish

general procedure of tissue building

needle is directed through the areolar tissue to the most distant point of the concavity -kept close to the skin as possible -injection into deep tissue is ineffective -*as pressure is applied on plunger, the needle is slowly withdrawn to the point of entry* -external pressure is applied to distribute the lumped filler through the tissues

cancer of the cheek

often results in pulling the nose to the opposite side because of the natural tension of the muscles -they must be considered temporary sutures if the cancer is not removed until after embalming

blisters and pustules

opened before embalming

1. hypodermic injection of constricting chemical into the surface of the eyelids 2. excision of a "melon slice" section across the upper eyelid 3. removal of the under-surface of the upper eyelid 4. moving excess skin from upper eyelid under the upper rim of eyesocket

other possible treatments for black eyes

lip cement

placed behind the weather line of the mucous membranes

power incision sealer

placed in the cavity to absorb any ensuing moisture

masculature sutures/application of plaster of paris

placed on edges of calvarium before parts are placed on the cranium

hypodermic tissue building

post-operative treatment for emaciation in the face, neck, hands -never recommended before arterial injection because the accurate requirements cannot be predetermined -an area of low resistance is created

perforation of metallic eyecap with a large needle

produces a greater effect which may be expedient on extreme cases of dehydrated eyelids

wax attachment

provides a natural appearing anchor for hair -suggested for all short hair and hair line restorations

external pressure

reduced during embalming -cold compress, chemically saturated cotton compress may be built with several thinknesses of cotton, a bandage may be applied to the neck, or water bags may be applied to the eyes

loose, wrinkled skin

reduction of swelling (black eye) results in_____ which may be more unsightly than the distention -upper eyelid is abnormally enlarged

hair restoration

serves as a frame for the face -no great talent is necessary to restore, merely patience

separated mucous membranes

slight separation of the lips -may be restored by means of hypodermic tissue building -entry of needle is made into both end of line of closure, for both upper and lower lips

slight dislocated bones of the cranium

sometimes may be retracted by a forceful impact with the heel of the hand on the undamaged side while the affected side is supported with the other hand

padding beneath the eyelids

sometimes needed -a thing flat piece of cotton, peeled from the mass and rounded to the size of the eyeball provides a better result than small pellets

incised to express humor/aspirated

surgical reduction of protruding eyes

holding long hair away from the lips of the incision with large clamps

suturing the scalp may be simplified by...

eccymosis (black eye)

swelling and discoloration results in the eyelids and adjacent areas from a forceable impact on or near the eye -capillaries within the eyelids rupture and blood escapes into the intercellular spaces -after the blood coagulates, it is not readily removed by aspiration

lancing and aspiration

swollen tissues caused by the collection of edematous fluid may be ____ during embalming

hypodermic needles

the larger diameters are practical for a cream filler and the narrow diameters for a liquid filler -higher the gauge, smaller the diameter -lower the gauge, bigger the diameter

cardboard foundation

thin cardboard or a business card may be bridged across the gums

posterior edge of the upper eyelid

touches the anterior edge of the lower eyelid

dehydration of the margins of the eyelids

upon completion of the eye enucleation, the cotton packing may be moistened to minimize....

fresh cotton of mortuary putty

used to simulate the absent eyeball -over this, an eyecap is placed and the eyelids are cemented together

electric spatula

value is limited -must be used hot, as cold tissue cools it is withdrawn until the heat mounts again

stretching with aneurysm hook

way to satisfy the dehydrated difficulty of abutting the eyelids before embalming

epidermis is removed

when skin slip occurs...