Restorative Art Notes PDF

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Restorative Art Notes  Can we see them- Family’s first question  JOEL E. CRANDALL o • Father of Restorative Art o • First to use photographs o • First to use wax o • First to develop reconstructive embalming methods for cases of cranial/facial trauma o • First to use hidden sutures in restorative art cases o • First to use cosmetics to blend to natural skin tones  Books o Manual of Restorative Art- Charels O Dhonau, G. Joseph Prager o A Textbook of Facial Reconstruction- Gladys p. Gurry o Postmortem restorative art- g. joseph prager  Emmett Till- let them see what I see, let the world see what they did to my son- mrs. till  The American way of death- Jessica Mitford o Gave funeral homes bad name o Said they were only in it for the money  JFK- assassinated and closed casket, every presidential funeral has been that way since  Response of the funeral service profession o Scared of public outcry / bad publicity o • Did not defend or protect what we knew to be true o • Thought of other ways to generate revenue o • Took the emphasis of the funeral away from the viewing of the dead o Told the public what we thought they wanted to hear o • Began offering cheaper alternatives to avoid bad press  Consequences o • Restorative Art texts stop being published o • Restorative Art schools closed o • Restorative Art education became watered down and almost non-existent o • Decades later we find generations of funeral directors with little to no knowledge in restorative art  FACT: 2015 NFDA Convention saw only 7% of all seminars or workshops related to embalming. Of that 7%, only TWO seminars touched on the subject of restorative art  FACT: Most mortuary schools now offer only one semester of restorative art. Which usually covers basic anatomy and color theory; almost no schools are teaching advanced restorative art or reconstruction techniques  What hasn’t changed o The importance of restorative art and seeing the dead o AS PROFESSIONALS WE MUST DEVOTE OURSELVES TO THIS CAUSE. o WE MUST UNDERSTAND THAT WE ARE THE ONLY ONES WHO CAN ALLOW THE ANSWER TO BE “ YES ” o OUR RESPONSIBILITY IS GREAT; o WE MUST BE STEWARDS OF OUR EDUCATION AND OUR PROFESSION.  Restorative Art defined- Care of the deceased to re-create natural FORM and COLOR to produce the most natural appearance possible

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How do we create natural FORM & COLOR?? o YOU must be the expert on factors that determine success or failure o The family, medical examiner, support staff, etc. do not have your knowledge base Factors to consider Classification of restoration: o minor or major? o Timing of restoration: before, during or after embalming? o Physiognomy- knowledge of structure and markings of the face and skull Classification of restoration: Minor Restorations o require minimal effort, skill and time o hypodermic tissue building, surface or lip wax work, concealing minor discolorations, correcting misaligned bones, etc Classification of restoration: Major Restorations o Require time, advanced skill and effort o Surgical repair, deep wound repair, dismemberment, decapitation, cranial & facial reconstruction, massive trauma, crushing injuries Timing of Restoration: Pre-Embalming Treatments o Setting of features, shaving, securing large fractures, re-aligning nose or mouth, etc o Remember: Embalming fluid will make tissue firm, rigid and dry once it is introduced to the system. Timing of Restoration: Treatments during embalming o Internal tissue building (high rate of flow) o Maintaining feature positioning Timing of Restoration Post-Embalming Treatments o Removal of scabs or mutilated tissues o Hypodermic tissue building o Wax restorations o Correcting major discolorations or trauma o REMEMBER: Restoration requires FIRM, DRY tissue!! Timing of cranial/facial trauma repair o GENERALLY, repair of cranial fractures takes place before embalming and repair of facial fractures takes place after. Remember: YOU determine the severity, level and outcome of the restoration o Examine the remains thoroughly o Do not base your opinion on what others say or think Physiognomy o Study of structures and surface markings of the face and its features o i.e. understanding the curvatures and anatomy of the head as well as the eyes, ears, nose and mouth Why all the confusing words? Whats the big deal? o To be taken seriously as a professional, one must be able to speak as a professional. o Anatomical Position o Body is upright, feet forward, arms to side with palms forward and thumbs pointed away from body

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Anatomical Terminology o Superior vs. Inferior o Anterior (ventral) vs. Posterior (dorsal) o Medial vs. Lateral o Projections vs. Recession o Concave vs. Convex o Distal vs. Proximal Physiognomy: What influences form and shape? o Anatomical structures: bone, muscle, skin etc. o Genetics, aging, environment, nutrition and disease all affect these anatomical structures Physiognomy: What influences form and shape? o 2 major factors that GENERALLY predetermine physiognomy o SEX and RACE Modern genetics & biology recognize 2 sexes and 3 primary races o Male or Female o European, Asian, and African o NOTE: skin color is determined by levels of melanin and carotene in the body. Higher melanin = darker skin color REMEMBER: o Physiognomy is concerned with the shape and form of both the head & face and its 4 major features European Cranium o Long, narrow head & face o Vertical forehead o Little or no supraorbital margins European Nose g o LETPORRHINE (narrow nose) o long & narrow o high root of nose o straight, concave or convex o thin tip and thin fleshy wings European Eyes o Horizontal eye closure o inner canthus is slightly superior to outer canthus European Mouth o moderate, nonelevated lips o pronounced philtrum o pronounced "hunters bow" European Ear o Moderate length o large, free lobe o flat helix Asiatic Cranium o Shortest skull length o Vertical forehead

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o No supraorbital margins o Short, wide face o layer of fat over cheekbones o Square jaw o Flat/Round shape Asiatic Nose o MESORRHINE (intermediate) o Concave profile o Low root o Medium width o Flared wings o Round tip Asiatic Eyes o Sloping eyes while closed o Outer canthus is superior to inner canthus Asiatic Mouth o Moderate, non-elevated lips o Pronounced philtrum o distinct "hunters bow" o same as European mouth Asiatic Ear o Long, thin ear o large lobes o unrolled helix African Cranium o Long skull o Vertical sloping forehead o Supraorbital margins o Projection of jaw o Sloping profile o Narrower face than Asiatic but not as narrow as European African Nose o PLATYRRHINE (wide & flat) o low, wide root o prominent depression at root o straight or concave profile o Thick, flared tip African Eyes o Horizontal eye closure o Slight slope-- inner catnthus is slightly superior to outer canthus o Identical to European eye African Mouth o Thick, elevated lips o pronounced philtrum o distinct "hunters bow" African Ear

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o Short, wide ear o Small, attached lobes o Deeply rolled helix Skull composed of 2 parts: o 1. Cranium (8 bones) o 2. Face (14 bones) Functions: o 1. Protect the brain o 2. Support the jaw o 3. Anchor muscles o 4. Provide form Cranium (8 bones) o ✤ Frontal (1) o ✤ Occipital (1) o ✤ Parietal (2) o ✤ Temporal (2) o ✤ Sphenoid (1) o ✤ Ethmoid (1) **internal Cranial Sutures o ✤ Fibrous bands of tissue that connect bones o ✤ Appear as intricate interlocking pieces Cranial Sutures o ✤ 18 total cranial/facial sutures o ✤ 1. Coronal o ✤ 2. Sagittal o ✤ 3. Lambdoidal o ✤ 4. Squamosal Importance of Sutures in Restorative Art o ✤ Serve as guideposts/ landmarks o ✤ "Begin with the known"\ o high velocity impact often causes sutures to separate before bones fracture o Repairing separated sutures offers stabilization of cranium as well as correct form and shape o ✤ Sometimes there are no ancillary fractures or shattered bones--- just separated sutures **most commonly seen in cases of GSW with handguns. Cranial Bones o Frontal Bone  ✤ Forms anterior 1/3 of head  ✤ Joins parietal bones at coronal suture  Forms forehead, roof of eye sockets, anterior of cranial floor  Anatomical Features of Frontal Bone  1. Frontal Eminences  2. Supraorbital Margins -Superior ridge of eye  3. Superciliary Arches -Superior to medial ends of brow  4. Glabella- elevation above root of nose  Typical Trauma to the Frontal Bone

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✤ Clean, medial fractures between the coronal suture and the glabella ✤ Clean fractures along the supraorbital margins ✤ Always examine damage before embalming and determine what areas need to be stabilized and when ✤ Be sure frontal bone has not become detached from facial bones or structures Fracture of Frontal bone along supraorbital margin

 o Occipital Bone  ✤ Base of cranium  ✤ Cradles the brain  ✤ Joins parietal bones at LAMBDOIDAL suture  ✤ Joins temporal bones at SQUAMOSAL suture  Anatomical Features of Occipital Bone  ✤ Foramen Magnum  Typical Trauma to Occipital Bone  ✤ Lateral hairline fractures that follow curvature of bone o Parietal Bones  ✤ Create superior portion of skull  ✤ Create posterior 2/3 of cranium  ✤ Joins occipital at LAMBDOIDAL suture  ✤ Joins temporal bone at SQUAMOSAL suture  ✤ Joins frontal bone at CORONAL suture  ✤ Joins opposite parietal at SAGITTAL suture  Anatomical Features of Parietal Bones  ✤ Parietal Eminence = widest part of the cranium  ✤ Vertex = highest part of cranium  ✤ Crown= top of cranium  Typical trauma to Parietals  ✤ Oftentimes will stay intact and separate at multiple sutures  ✤ Important to line sutures up exactly for proper shape o Temporal Bones  ✤ Form inferior sides and base of cranium  ✤ Joins parietal bone at SQUAMOSAL suture  ✤ Joins occipital bone at LAMBDOIDAL suture  ✤ Joins wings of sphenoid bone  Anatomical Features of Temporal Bones  ✤ Squama-- thin superior portion of bone where temporalis muscle attaches  ✤ Zygomatic Arch--extends from squama to zygomatic bone--above auditory meatus; divides length of ear in half--- WIDEST PART OF THE FACE  Mandibular Fossa-- Depression on underside that cradles mandibular condyle (jaw)  ✤ External Auditory Meatus-- opening for ear canal  ✤ Mastoid Process--rounded projection where SCM muscle attaches = WIDEST PART OF NECK  Typical Trauma to Temporals

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✤ Thin, unique shape of bone often leads to shattering in many pieces ✤ Have patience! ✤ Use the unique anatomical features to your advantage ✤ "Start with the known"

o Sphenoid  ✤ Mostly internal--- forms anterior portion of the base of the skull  ✤ Wings of sphenoid are visible at junction of frontal, parietal and temporal bones o Ethmoid  ✤ Internal bone of cranium  ✤ Forms roof of the nasal cavity and anterior base of cranium Facial Bones o Nasal Bones (2)  ✤ Forms bridge of the nose  ✤ Root of nose = where frontal bone meets nasals  ✤ Joins frontal bone and maxillas  ✤ Forms nasal cavity with maxillas o Zygomatic Bones (2)  ✤ Diamond shaped  ✤ Form cheek bones  ✤ Form inferior and lateral margins of orbital cavity  ✤ WIDEST PART OF FACE is measured from midpoint of one zygomatic to the other o Maxilla (2)  ✤ Forms roof of mouth, sides and floor of nasal cavity, floor of eye orbits and most of the superior portion of the face  ✤ Zygomatic Process = where maxilla meets zygomatic bone, NOT temporal bone (error in book)  ✤ Prognathism = "buck teeth" o Mandible  ✤ Forms lower jaw  ✤ Composed of horizontal body and vertical ramus, joined at mandibular angle  Mental Eminence-- triangular shaped projection on the inferior of anterior mandible---tip of chin  ✤ Incisive Fossa-- depression between mental eminence and inferior incisors  ✤ Coronoid Process-- anterior projection of ramus; insertion point of temporalis muscle  ✤ Condyle--posterior projection of ramus-- cradled by mandibular fossa of temporal bone; associated with dislocated jaw o Vomer, lacrimal and palatine bones  ✤ Small, intricate bones of nasal cavity with little use to restorative art Typical Trauma of Facial Bones o ✤ Unpredictable o ✤ Could be little to no damage or complete devastation

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o ✤ Case by case analysis is required o ✤ Don't form an opinion before you examine for yourself! Professional Considerations When Dealing with Facial Bone Trauma o ✤ Do the fractures need to be repaired or can the bones be manually manipulated back into place? o ✤ How to access the bones? o ✤ How to repair the bones?--- dont forget that they are covered with soft tissue o ✤ Final goal is always to re-create natural form Remember o ✤ Skeletal reconstruction, even the easiest cases, takes a lot of practice, patience and experience. You will not learn this overnight. o ✤ Trial and error --- you will experience many failures along the way--- don't give up! o ✤ It took Joel Crandall 10 years SOFT TISSUES OF THE HEAD, NECK & FACE o • Muscles - Cranial & Facial o • Fascia - Connective Tissue o • Integument (skin)- Epidermis & Dermis BORING THINGS TO KNOW ABOUT MUSCLES FOR YOUR BOARD EXAM • o ORIGIN = end of muscle attached to a fixed point; usually on immovable bone or cartilage o • INSERTION= attached to movable part or skin HOW MUSCLES RELATE TO RESTORATIVE ART o • Loss of muscle tone causes sagging of tissue o • Gravitational pull effects muscles = anteriorly and inferiorly on a living, upright person o • Laterally and posteriorly in a horizontal person o • Wrinkles cross muscles at 90deg. (right angle) o • Which way will family remember the person? MUSCLES OF THE CRANIUM & FACE o • Cranial • Mastication (chewing) o • Facial expression MUSCLES OF THE CRANIUM o • Occipitofrontalis (epicranius)  • Covers top of skull from occipital bone to eyebrows  • Raises eyebrows and wrinkles forhead  • Sometimes referred to as the epicranius OR as frontalis and occipitalis o • Temporalis  "Fan shaped" muscle on side of cranium  • Closes the mandible  • Strongest muscle of mastication  • Very common to atrophy and leave concavity in old age or sickness o • Masseter  Mastication  • Originates at zygomatic arch and inserts on ramus MUSCLES OF THE EYE (SURFACE) o • obicularis oculi

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 sphincter around eye socket  • closes eyelids  • compresses lacrimal sac  • Oculi = ocular o • corrugator  • "Frowning eye" muscle  • Located beneath frontalis & obicularis oculi  • small pyramid shape on medial end of eyebrows  • draws eyebrows down when frowning o • levator palpebrae superioris  Flat, long, triangular muscle  • Originates deep in eye socket on sphenoid  • Inserts on upper eyelid  • Raises eyelids  • Use the name to help you! Dont let it intimidate you. REMEMBER- LOSS OF MUSCLE TONE WILL AFFECT FACIAL FORM. MUSCLES OF THE NOSE o • PROCERUS o • Extends vertically from nasal bones to lower forehead o • Scrunches nose MUSCLES OF THE MOUTH o • Obicularis Oris  Sphincter muscle encircling mouth  • Closes and puckers lips  • Compresses lips against teeth  • What happens with no teeth o • Levator Labii Superioris  Elevates & extends upper lip  • Let the name help you o • Levator Anguli Oris  • small muscle at angle of mouth  • Elevates corner of mouth o • Zygomaticus Major  • "Laughing Muscle"  • Draws angle of mouth back and up, as in smiling or laughing o & Minor  • Draws upper lip superiorly & laterally o • Buccinator  • "Trumpeter's Muscle"  • creates "soft area" of the cheek and creates lateral wall of the mouth  • Compresses the cheeks and lips like blowing into a trumpet or using a straw o Risorius  Narrow superficial muscle that runs across the cheek  • Retracts angle of the mouth (opposite action of Buccinator) o • Depressor Labii Inferioris  depresses lower lip inferiorly and laterally

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o • Depressor Anguli Oris  Also called Triangularis muscle  • Depresses angle of the mouth as in frowning o • Mentalis  Tip of the chin  • Elevates and protrudes lower lip as in frowning with a pouty lip  • Wrinkles skin on chin when contracted POSSIBLE CAUSES OF FACIAL MUSCLE DAMAGE ATROPHY— o OFTEN OBSERVED IN THE ELDERLY, CANCER PATIENTS OR OTHER MALNOURISHING DISEASES o TUMORS OR GROWTHS o ACCIDENTS OR ACTS OF TRAUMA REMEMBER-- RESTORATION AIMS TO RE-CREATE NATURAL FORM AND REQUIRES FIRM, DRY TISSUE. MUSCLES OF THE NECK o • Platysma  • Broad, flat superficial muscle of the neck  • Extends from clavicle, ribs & shoulder up to bottom of chin o • Sternocleidomastoid  • Long, thick muscle passes obliquely across side of neck  • Used to measure widest part of the neck  • Rotates head o • Digastric  • Irrelevant to this class but on the board exam (???)  • lies below body of mandible and attaches to hyoid bone BRIEF COMMENTS ABOUT THE INTEGUMENT (SKIN) o • Epidermis is outermost layer; contains no blood vessels. 3/4 of it are dead cells o • Dermis is thicker inner layer. It contains adipose, blood vessels, sweat glands and hair follicles o • Skin is thinnest on eyelids o • Embalming dehydrates= keep skin moisturized!! o • Dehydrated skin can be a MAJOR problem FACIAL PROPORTIONS & SHAPES o BEAUTY IS IN THE EYE OF THE BEHOLDER ANCIENT EGYPTIANS OBSERVED PROPORTIONS OF THE HUMAN FORM o EGYPTIAN CANON  • The length of middle finger = approximately 1/19 the height of the body ANCIENT GREECE o • Closely studied anatomical proportions o • Developed the "Canon of Beauty" o • Serves as a basis of comparison THE EYES: GENERAL OBSERVATIONS o • "Open thine eyes for they are the window to your soul" THE EYES ARE THE CENTER OF THE HEAD- (HALFWAY BETWEEN VERTEX OF CRANIUM AND BASE OF CHIN THE FACE IS 5 EYES WIDE THE DISTANCE BETWEEN THE EYES EQUALS THE WIDTH OF 1 EYE

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THE WIDTH OF THE NOSE EQUALS THE WIDTH OF 1 EYE THE WIDTH OF THE MOUTH EQUALS THE WIDTH OF 2 EYES THE INNER CANTHUS OF THE EYES WILL LINE UP WITH THE WINGS OF THE NOSE THE PUPILS WILL LINE UP WITH THE CORNERS OF THE RELAXED MOUTH THE FACE IS EQUALLY DIVIDED INTO 3 PARTS o Hairline to eyebrow o • Eyebrow to base of nose o • Base of nose to base of chin THE LOWER 1/3 OF THE FACE CAN BE DIVIDED INTO 3 EQUAL LENGTHS o Base of nose to line of lip closure o • Line of lip closer to top of chin o • Top of chin to base of chin THE TOP OF THE EAR IS ON THE SAME HORIZONTAL PLANE AS THE EYEBROW THE BOTTOM OF THE EAR IS ON THE SAME HORIZONTAL PLANE AS THE BOTTOM OF THE NOSE THE LENGTH OF THE EAR IS EQUAL TO THE MIDDLE 1/3 OF THE FACE THE LENGTH OF THE EAR IS EQUAL TO THE DISTANCE BETWEEN THE CORNER OF THE EYE AND THE EAR PASSAGE EYEBROW TO BASE OF CHIN = TIP OF NOSE TO EAR PASSAGE GENERAL OBSERVATIONS o • The width of the face is 2/3 the height of the face o • The average human being is 7.5 head lengths tall COMPARING PHOTOGRAPHS TO ACTUAL SUBJECTS o • Start with a known feature-- both on the photo and subject o • Measure in centimeters -- the math is easier o • Use the basic formula Photo/Subject COMPARING PHOTOGRAPHS WITH ACTUAL SUBJECTS o • "Start with the known" o • We know that the mouth is 2 eyes wide o • Measure the width of the eye on the deceased and compare it to the width of the eye in the photo o • Measure the width of the mouth in the photo o • Use formula P/S to solve for the unknown FACIAL SHAPES o • Profile view o • Frontal view o • Bi-Lateral view PROFILE SHAPES OF THE HEAD o • Identified using terms vertical, convex or concave o • Concerned with how forehead relates to eyebrows and how upper lip relates to chin. Vetical Concave Convex ...