Mouth and Eye “Snow” Assignment
**Use “The Mouth” PowerPoint slides as a guide when completing this assignment.**
Slide #1: “Natural Facial Markings Associated with the Mouth”
Note the diagram on page 30 of the RA text. The “Natural” Facial Markings are on the left side of the face and the “Acquired” Facial Markings are on the right side.
Be sure to look up the definition for each of the markings in the Funeral Service Vocabulary book.
This lecture focuses only on the “natural” facial markings.
Slide #2: Note there is only 1 other “natural” facial marking to be covered. This is because the muscular movements of the mouth account for the majority of the natural facial markings that are found on the face.
Slide #3: “Prognathism”
Turn to page 51 in the RA textbook. You will note that there are 4 types of prognathism mentioned at the top of the page. There is a fifth type that you are responsible for and it is called “infranasal”.
Be sure to look up the definition for each in the Funeral Service Vocabulary book.
Slides # 4 - #10: These pictures were taken in the embalming lab last year.
Slide #5: The decedent’s lips are being coated with massage cream. This will help to reduce any trauma to the tissue as a result of “manipulation” of the mucous membranes.
Slide #6: The student is “gently” manipulating the mucous membranes digitally and with an aneurysm hook in an attempt to bring the them together. This is the most CONSERVATIVE treatment and therefore it is done first. In some cases this may be all that is necessary in order to approximate the mucous membranes.
Slide #7: The student is placing a “pledget” (look this word up in the Funeral Service Vocabulary) of cotton behind the inferior mucous membrane in an attempt to restore the natural surface form of the mouth.
Slide #8: The student is placing a product called “Kalip” over the teeth. This will help the superior and inferior mucous membranes to stay in place.
Slide #9: Tissue adhesive is being placed BEHIND the “weather line”. It is best applied as “single drops” approximately ½ inch apart rather than a continuous line. This will help prevent the product from leaking onto the skin surface and causing a “powdery residue” that is impossible to cosmetize over.
Slide #11: “Mouth and Lip Restorations”
Turn to page 53 in the RA textbook and also pages 545 – 546 in the Mayer Embalming textbook.
1) resetting the jaws and lips: If the mucous membranes are postured too tightly they will create an unnatural “clenched” expression. This often happens when the decedent has no teeth. It is important to loosen or tighten the ligature or wire in order to maintain a natural expression.
The line of closure may also “widen” as a result of gravity during the embalming procedure.
2) tissue building: Tissue builder can be hypodermically injected beside the nasolabial folds. Cotton or mortuary putty may also be usjed to restore projection around the mouth.
3) elevation of the angulus oris eminence beside the wing of the nose: **I will be giving you a diagram to illustrate this procedure.**
This results in projection of the “smile eminence” and produces a pleasant appearance.
4) cosmetizing: The inferior mucous membrane can be cosmetized to appear wider than the superior mucous membrane. Cosmetics can only be used to “slightly” widen the appearance of the inferior mucous membrane and this will be discussed in a later class.
Slide #12: “Dental Prognathism”
**Note the methods listed on pages 53 & 54 (RA textbook) and also on page 545 (embalming textbook).
Some of the methods listed would be considered MAJOR restorations and should only be attempted as a last resort. E.g. bullet points #6, #10 & #11 on page 54
REMIND ME TO DEMONSTRATE THE “WET COTTON SLINGS” METHOD IN CLASS NEXT WEEK!!
Slide #13: “Support for Lips When Part or All of the Teeth are Missing”
Turn to page 54 (RA textbook) and page 545 (embalming textbook).
The most common type of “filler” used is mortuary putty.
It is important to consider “wicking” when filling the oral cavity. If webril or regular cotton is used, it may need to be replaced after the embalming is finished. Mortuary putty and non-absorbent cotton will not “wick”.
An emollient is best placed over the cotton/webril before positioning the mucous membranes. This will help to reduce the effects of dehydration and reduce the risk of the lips separating.
Slide #14: “Dehydrated Lips”
Turn to pages 531 – 533 in the embalming textbook.
SEVERELY dehydrated lips can ONLY be restored using lip wax!!
Slide #15: “Cementing Lips”
Turn to page 533 in the embalming textbook and page 54 in the RA textbook.
“Swollen Lips”
May be caused by decomposition, injury, pathology or embalming.
Methods of reduction:
1) electric spatula: effective for small areas
- must be used hot and as the cold tissue cools it, it is withdrawn until the heat mounts up again
- massage cream is applied to the skin to avoid burning…..as the cream melts it is immediately replaced
2) aspiration: hypodermic syringe is used and the point of insertion is the lateral corners of the mouth
3) external pressure: wet a piece of cotton with cold water and apply it to the surface of the mucous membrane using digital pressure
Slide #17: “Profile Forms of the Eye”
**I will have a handout for you that will better illustrate this concept. We will go over it in class.**
Slide #19: “Sunken Eyes”
Turn in the RA textbook to page 57 and in the embalming textbook to page 544.
When hypodermic tissue building, the needle is inserted between the lips of the inner canthus at the medial ends of the eyelids.
Slide #20: “Swollen Eyelids”
When using the cavity fluid compress, be careful not to oversaturate the cotton. This can result in the cavity fluid running down the sides of the face and bleaching that tissue.
Dehydrating agents are simply high index fluids that are injected. The process of “osmosis” results in the reduction of surface form.
Surgical reduction is considered a MAJOR restoration and should only be done as a last resort. The tissue beneath the surface of the superior and inferior palpebrae is excised.
Modification of excess wrinkles may be necessary, because the swollen tissue has stretched.
Slide #21: “Discolored Eyes”
Turn to page 57 in the RA textbook.
When bleaching be careful not to oversaturate the compress resulting in the high index fluid running down (and bleaching) the sides of the face.
Slide #22: “Wrinkled Eyelids Caused by the Reduction of Swelling”
Turn to page 57 in the RA textbook.
3) Excision of part of the eyelid. This type of procedure would definitely require WRITTEN permission because it is a MAJOR restoration. The excision will reduce the surface area of the eyelid and the remaining lid can be stretched over the eyeball.
3) Electric spatula: care must be exercised near the edges of the eyelids because it is possible to make the margins curl outward and also damage the eyelashes. Therefore, avoid extensive and direct contact with the marginal edges and use plenty of emollient.
Slide #23: “Protruding Eyes Caused by Projection of the Eyeball”
Turn to page 57 in the RA textbook and page 545 in the embalming textbook.
1) cranial aspiration: not the most CONSERVATIVE treatment, and would result in possible leakage from the nares
2) aspiration behind the eyeball: this is the OPPOSITE of injecting tissue builder into the “pads” behind the eye, and uses the same technique
3) aspiration inside the eyeball: an invasive procedure that may result in leakage so…..not personally recommended
4) external pressure: emollient may be placed on the eye and gentle digital pressure applied
- again, I recommend that you soak a cotton ball with cool water and place it between your fingers and the eye
- this is a CONSERVATIVE treatment, and should be the embalmer’s first choice
5) removal of the humor of the eyeball: a surgical procedure that is NOT CONSERVATIVE and would definitely result in leakage
A condition known as “exopthalmia” can result when a person has a goiter due to a condition of the thyroid gland. In life, the eyes are noticeably “bulging” and friends and family are used to seeing them this way. However, in death, the eyes must be closed. For this reason, I would speak to the family at the arrangement conference regarding the condition and tell them “We will do the best that we can.” It would then be important to secure WRITTEN PERMISSION in case a less conservative treatment must be done.
In the aforementioned condition, the profile of the eye may be more pronounced than normal, however, as long as the eye is closed, I would not be alarmed. Remember, family and friends are used to seeing the decedent with “bulging” eyes.
Slide #24: “Lacerated Eyelids”
Turn to page 58 in the RA textbook.
The 3 techniques mentioned on the slide are thoroughly discussed at the top of page 58.
Remember, to always start with the most CONSERVATIVE treatment.
Slide #25: “Separated Eyelids”
Turn to page 58 in the RA textbook and pages 544 – 545 in the embalming textbook.
Treatments #1, 2 & 4 are the most conservative and would be the best place to start. Remember that the line of eye closure must be in the lower third of the orbit.
Treatment #3 is a SURGICAL procedure and certainly is not conservative. You may remember that the levator palpebrae superioris is the muscle which elevated the upper eyelid. By severing this muscle, the upper eyelid will “fall” to meet the lower eyelid. The risk of leakage is heightened with this procedure, and written permission is definitely required for this major restoration.
Treatments # 5 & # 6 are the same as mentioned with the previous slide on lacerations. Neither is conservative and written permission would be required.
Slide #26: “Orbital Pouch”
Turn to page 58 in the RA textbook.
The 3 treatments presented on the slide are explained in detail in the textbook. Treatments #1 & #3 are the most conservative and therefore recommended.
The 2nd treatment (aspiration) may increase the risk of leakage and it would be important to close the entry point with glue.
Slide #27: “Dehydrated Inner Canthus”
Turn to page 58 in the RA textbook.
This is a condition that I am confident you have all had to deal with.
1) Cementing: When using tissue adhesive, be sure to direct it deep into the inner canthus and only use a tiny drop. This method will reduce unsightly residue that can occur.
2) Waxing: Generally lip wax or light “surface restorer” wax is required. I like to mix a drop of the basic complexion colorant that I am using into the wax. This helps it “blend in” with the surrounding tissue.
Enucleation Treatment: The written exercise that you did for me covers all of the necessary information for this section.