Final Exam Restorative Arrts PDF

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Final Exam  The Mouth Anatomy, Relevance and Basic Restorative Procedures  Internal Anatomy of the Mouth o ❖ Houses the oral cavity o ❖ Site of mastication o ❖ Beginning of alimentary canal  External Anatomy of the Mouth o ❖ BORDERS OF THE MOUTH o ❖ Superiorly- columna nasi o ❖ Laterally- nasolabial folds o ❖ Inferiorly- labiomental sulcus / mental eminence o Superior Mucous Membrane  * 5 curves (3 descending, 2 ascending  * "Hunters Bow" shape  *Medial Lobe - tiny prominence on midline  *Narrows laterally towards line of closure o Inferior Mucous Membrane  Thicker than superior membrane  "U shaped" curvature o Superior Integumentary Lip  Between base of nose (columna nasi) and superior margin of superior mucous membrane o Inferior Integumentary Lip  Between inferior border of inferior mucous membrane and labiomental sulcus o Line of Closure  *Forms between 2 mucous membranes when moth is closed  *Usually located at lower border of upper teeth  *"Hunters Bow" shape o Weather Line  *Demarcation between wet and dry portions of mucous membranes  *Where mortuary glue is applied for lip closure  Associated Facial Markings o ❖ Philtrum- superior integumentary lip that dips in o ❖ Angulus Oris Sulcus- mouth o ❖ Angulus Oris Eminence –mouth o ❖ Labial Sulci- inside mouth o ❖ Labiomental Sulcus- chin line o ❖ Nasolabial Folds & Sulci- curve on nose wings and line in cheek made from them  Differences of sex and age o * Fullness of lips women have fuller, rounder lips o * Definitive borders women usually have sharply defined borders between integument and mucous membranes o less of a contrast with men o Role of gravity and aging o Loss of teeth?

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o Fullness of face and lips Importance of the Mouth o The mouth is the most-complained about feature in the funeral home setting. o ❖ "It just doesn't look like her" o ❖ The mouth is the most mobile of our facial features o ❖ What happens when you move your lip just a 1/4 inch? o ❖ PROPER MOUTH CLOSURE o ❖ Lips comfortably meet o ❖ Proper width and height o ❖ Visible line of closure o ❖ Proper bilateral curvature o ❖ Properly cosmetized o ❖ Natural imperfections are OK! What Could Possibly Go Wrong? o ❖ Swollen lips o ❖ Emaciated lips/face o ❖ Prognathism o ❖ Mouth too wide o ❖ Lips too high o ❖ Absence of teeth o ❖ Mouth closed too tight/loose o ❖ Mouth unnaturally shaped o ❖ Lips discolored / poor condition o ❖ Mouth destroyed (caper status) Lips discolored / Poor condition o Typical in cases where remains have been dead for an extended period of time o PROPER EMBALMING TECHNIQUE AND FLUID SELECTION  * Restricted Cervical Injection  * Higher solution strength  * Proper use of humectant  * Securing good drainage from jugular will greatly help coloring Mouth Closed Too Loose o Mucous membranes should comfortably but gently touch eachother o A slight gap at beginning of embalming is ok. Why? Mouth Closed Too Tight Irregular Projection Irregular Curvature o All of this could have been prevented during feature setting. o What would you do differently? Irregular facial markings "Planet of the Apes" mouth o These problems are past being able to be corrected once the remains are embalmed and firmed. Unnatural Bilateral Curvature o Use cotton to position lips properly o This is caused by laziness/ Jabroni behavior Mouth Too Wide o Corners of mouth should line up vertically with pupils o Use lip wax on corners to narrow mouth.

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o You only need a SMALL amount!  Frowning Mouth o Manually manipulate mouth during embalming. o Tissue builder in angulus oris eminences will help draw mouth up o Use of slings to create nasolabial folds and sulci  Swollen/Damaged Lips o Common in motor vehicle accidents o Proper Embalming Technique o Proper Fluid Selection o Establish Proper Shape/Curvature o Smooth Tissue With Wax o Cosmetically alter height of lips  Mouth/Lips SOFT TISSUE Destroyed or Missing o Knowledge of anatomy is essential o GOAL: Restore natural FORM and COLOR o DO NOT FORGET BI-LATERAL SYMMETRY! o Proper Embalming Technique o Proper Fluid Selection o MUST have completely DRY, FIRM tissue!! o Skeletal damage must be repaired first to provide proper shape and foundation.  Extreme measures to close a traumatized mouth o What can we do to make the mouth look naturally closed? o ❖ In cases of severe trauma, weigh your options. Are your actions likely to make the situation better or worse than they already are?  Extreme measures; thinking outside of the box o 1. Carefully measure the distance between the lips o 2. Hold on to your butts o 3. Use a new, sharp scalpel and surgically alter the chin Anatomy of the Ears and Eyes  Anatomy of the Ear (PINNA) o ✤ Changes less than any other feature during lifetime o ✤ Greatest variation from physiognomical "norm" o ✤ Narrows inferiorly o ✤ Greatest width is 2/3 the length o Essential knowledge for the National Board Exam o ✤ Limited practical applications o ✤ Confusing terms and diagrams (??) How do you learn this information? Literally "piece by piece" o ✤ Observe the shapes and folds of the ear  CONCHA o ✤ Conch = shell o ✤ "C" shaped curvature o ✤ Middle 1/3 of the ear o ✤ Deepest depression of the ear  HELIX o ✤ Outer rim of the ear

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o ✤ Shaped like a question mark o ✤ Blends directly into facial tissue at end of superior curvature ANTIHELIX o ✤ "Anti" = opposite o ✤ Inner rim of ear o ✤ Thicker than helix o ✤ Forms superior and posterior walls of the concha SCAPHA o ✤ Fossa between the helix and the antihelix o ✤ shallowest depression of the ear o ✤ Blends seamlessly into lobe CRUS o ✤ Origin of the helix o ✤ Flattens and ends in concha o ✤ Generally lies over the zygomatic arch = used to determine center of the ear (1/2 the length) CRURA o ✤ Bifurcating branches of the antihelix TRIANGULAR FOSSA o ✤ Depression between branches of the crura. o ✤ 2nd deepest depression of the ear TRAGUS o ✤ Elevation protecting external auditory meatus o ✤ Protrudes directly from facial tissue ANTITRAGUS o ✤ "Anti" = opposite o ✤ Obliquely opposite the tragus o ✤ Prominence varies from person to person INTERTRAGIC NOTCH o ✤ Notch between the tragus and the antitragus LOBE o ✤ Do I really need to tell you where an ear lobe is? o ✤ Can be attached or unattached o ✤ General racial differences? (Lecture #2 - physiognomy) External Anatomy of the Eye o ✤ Delicate tissue and complex shapes make the eye(s) prime candidates for restorative treatments. o ✤ Without knowledge of the anatomy you will not succeed. o ✤ Anatomical terms are National Board Exam material SUPERIOR PALPEBRAE o ✤ "upper eyelid" o ✤ Wider than lower eyelid o ✤ 3 times taller than lower lid o ✤ Creates upper 2/3 of properly closed eye INFERIOR PALPEBRAE o ✤ "lower eyelid"

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o ✤ narrower and thinner than upper eyelid o ✤ overlapped by upper lid at the later end o ✤ follows curvature of the eyeball  NASAL ORBITAL FOSSA o ✤ Depression between superior, medial part of eye and the root of the nose  INNER CANTHUS o ✤ Small elevation at medial corner of upper eyelid o ✤ There are no eyelashes here o ✤ Common to dehydrate and separate in embalmed remains  CILIA o ✤ Eyelashes o ✤ Cilia on upper eyelid turn up o ✤ Cilia on lower eyelid turn down o ✤ KEEP THEM CLEAN o ✤ heat will cause eyelashes to curl unnaturally  SUPERCILIUM o ✤ Eyebrows o ✤ Grows upward and laterally- NBE question o ✤ Thicker near the glabella  SUPERIOR ORBITAL AREA o ✤ Region between the eyebrow and the upper eyelid. o ✤ Deepest near root of nose o ✤ Composed of muscle and fat  Supraorbital Margin o ✤ Superior rim of the eye socket o ✤ Anatomical feature of the frontal bone  COMMON PROBLEMS WITH EYES o Sunken eyes  ✤ Most common problem with eyes in mortuary setting  ✤ Don't be scared to inject the eyes  ✤ Building up eyes is ALWAYS a postembalming procedure. Why?? o Small changes make big differences o Swollen eyes o Badly discolored & damaged eyes o ECCHYMOSIS- a subcutaneous spot of bleeding (from extravasation of blood) o Lacerated / torn/ destroyed eyes o No eyes (cornea / eye donors) Informed Chemical Selection & Dilution  Fundamental Knowledge o • How many oz. in a standard bottle of embalming fluid?  16 ounces o • How many oz. in a gallon?  128 ounces o • How many gallons in a standard embalming machine?  3 gallons o • How many oz. in a standard embalming machine?

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 384 ounces o • Weight of 1 gallon of water?  8.3 punds o • How many gallons of embalming solution in a standard human body?  1 gallon per 50-75 pounds o • Definition of "index"  grams of formaldehyde dissolved in 100 mL of water A proper working knowledge of embalming chemistry will help you be successful in any situation or setting. Purposes of Embalming Fluid o • Tissue fixation - how?? o • Inhibiting further decomposition o • Killing microorganisms o • Destroying odors o • Preservation takes precedence over presentation, but both are important. Major Types of Preservative Compounds o • Aldehydes o • Alcohols o • Phenolics o • Note that ALL are organic compounds o • Formaldehyde vs. Gluteraldehyde? Arterial Fluid o • Composed of preservative AND specialized supplements o Supplements can be included in arterials OR be added by the embalmer Germicideso kill bacteria i.e.: STOP = treats tissue gas Anticoagulants o • Work to destroy clots and lower calcium levels in water and blood Surfactantso help break surface tension of cellular water Humectants o • Moisture retaining fluids Bufferso balance pH of solution. Why?? Vehicles o • Liquid medium used to carry chemical to system o • Why a liquid medium? o • Considerations-- how does vehicle react to solution? to system? o • Embalming vehicles = water, methanol, glycerin Professional Considerations o • Effect of drugs on system? o • Effect of drugs on solution? o • Damage to organs? o • Time between death & prep o • Time between prep & disposition o • Weight

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o • Amount of muscle vs. fat o • Cause of death o • Temperature o • Trauma or disease? THE KEY TO PROPER FLUID SELECTION LIES IN THE DILUTION STRENGTH OF THE SOLUTION The importance of understanding dilution strength o • do NOT base your solution on a "home brew" or "standard mixture" o • do NOT base your solution solely on index o • index is worthless when not taken in context with dilution strength of total solution o • "average index strength" of an arterial fluid = 18-28; important knowledge that is worthless if you don't know the dilution strength. "Normal Case" o • 1% - 2% dilution strength "Moderate Case" o • 2% - 3% dilution strength Difficult Case / Basic Trauma o • 3% - 4% dilution strength Advanced Case / Disaster Capers o • 6% - 20% dilution strength Decomp / Complete Tissue Destruction Cases = WATERLESS SOLUTION Calculating Dilution Strength • Multiply oz. of arterial fluid used by index of fluid and divide by oz. of water used • ounces x index/ozH20 • OR CxV=C1xV1 • (index X oz fluid = dilution X total volume) Calculating Dilution Strength o • Multiply oz. of arterial fluid used by index of fluid and divide by oz. of water used o • ounces x index/ozH20 o • OR CxV=C1xV1 o • (index X oz fluid = dilution X total volume) Using 2 bottles of 30 index... • o Dilution Strength in 1 Gallon? o • 30 x 32 = 960. 960/128 = 7.5% o • Dilution Strength in Tank? o • 30 x 32 = 960. 960/384= 2.5% o • BUT WAIT THERE'S MORE! o • This example assumes that 384 oz. of water (full tank). Is this realistic???? o • Assumes placing 3 gallons of water in machine FIRST, then adding fluid Secondary Dilutions o • Extreme edema will diminish your dilution strength. Why? o • Ask family or hospital how much weight the person has gained in fluid. o • 1 gallon of water = 8.3 pounds. o • "Dad gained 50 pounds on life support" o • 50 pounds of water retention translates into how much extra water? o • 50lbs./8.3 lbs per gallon = extra 6 gallons of water in system.

o • What we thought was a 3.3% dilution (960/288) is in fact a 0.9% dilution (960/1056oz. water) ...