Lecture Notes- Continued MORS 113 Flashcards
- Disinfection of oral and nasal cavities
- Remove and record all clothing and personal effects
- Disinfection of clothing when necessary
- Remove all medical dressing and devices
- Bathe- external disinfection
Initial Treatment of The Body
These medical devices are removed after embalming.
Intravenous
Should be documented in a permanent file.
Removed clothing and personal belongings
- Materials and proper procedure- aerosols sprays, topical jelly and cavity packs
- Cleaning and disinfecting agents
- Protect all identification tags and bands
Bathe - External Disinfection
This is something to be done prior to embalming.
Position the Body
Body should be placed on a table with the head elevated _____ the rest of the body.
Above
Be sure the body is ______ on the table.
Straight
The head should be placed on the ______ in such a way that it will not interfere with the distribution of fluid and drainage.
Headrest
The face may be tilted to the right, no more than ____ degrees, which is the generally preferred casketing position.
15
The _____ must be aligned in such a way that there will be no interferences with distribution of fluid and drainage.
Neck
_____ should be placed in a desirable position. (Left over right)
Hands
____ may need to be elevated or otherwise posed for effective positioning of the hands.
Arms
________ may need to be elevated to effect proper neck alignment.
Shoulders
The use of additional _____ ______ _____ may be necessary in special situations for proper body positioning.
Impermeable Posing Devices
Be sure ________ do not abrade surface tissue causing desiccation marks.
Instruments
- Shaving
- Prepare the face with cream or oil (optional)
- Closing the mouth
- Closing the eye
- Positioning the arms and hands
- Positioning the head
- Prepare face and hands- massage cream
- Raise artery and vein- begin embalming process
- Wash and dry hair
- Pack external orifices
- Bathe entire body
- Fingernails cleaned
- Hair cut and styled
- Prepare to dress and casket
Posing the Features to Create Feature Naturalness
The application of this at this time may have the following effects:
- Cleanse tissue pores
- Retard dehydration
- Base for further massage
- Base for cosmetics
- Stimulate circulation
Massage Cream or Oil
Will fill the pores of the skin and prevent the face from soaking in cosmetics.
Massage Cream- Base for Cosmetics
- Excessive manipulation of the lip tissue can cause distension (swelling).
- Sharp teeth can cause personal injury to the operator.
Precautions of Closing the Mouth
- Relieve rigor mortis
- Disinfect and cleanse oral and nasal cavities
- Remove, cleanse and disinfect dentures
- Observe normal overbite
- Observe points of natural expression
- Secure the mandible
Starting Procedure- Mouth Closure
Run copious amounts of water through the nostrils, then use the nasal aspirator to remove excess water.
Disinfect and Cleanse Oral and Nasal Cavities
Use a small, stiff brush. As for the dentures at the place of death if possible.
Remove, Cleanse and Disinfect Dentures
- Natural teeth
- Dentures - 90% accuracy
- Mouth formers
Observe Normal Overbite
- Five arcs of lip closure (hunting bow)
- Protrustion of the upper lip
- Natural facial lines and acquired facial lines
- Corner of the mouth slightly raised
Observe Points of Natural Expression
Shape of the mouth
Horseshoe
Shape of the line of closure of the lips.
Hunting Bow
- Naso-labial fold
- Philtrum
Natural Facial Lines
- Labial sulci
- Naso-labial sulcus
Acquired facial lines
To make the deceased look restful and peaceful.
Raise the corner of the mouth slightly
- Print name
- Social security number
- Date of birth
- Date of death
- Name of funeral home
- address
- phone number
- The tag must have protected laminate (encased impermeable plastic).
Maryland requires that identification tags be attached to a long bone after embalming.
- Needle Injector
- Muscular suture or tie
- Mandible suture or tie
- Wire through the bones
Acceptible Methods of Securing the Mandible
This is only used in special situations, usually trauma. The mandible is wired to the maxilla after small holes are drilled with a dremel (acceptible).
Wire Through the Bones
- Chin rest
- Dental Tie
- Hypodermically injecting the masseter muscle
- The tack and thread method
- Drywall adhesive
Outdated, unreliable and in some cases, unethical methods of mouth closure
Outdated. The mouth is closed and a head-block, bottle or nose-chin clamp is positioned. Both carotids are raised and the head is over-embalmed. These positioning devices are left in place until the facial tissue and muscles are firm, then they are removed. The theory is that the tissue is fixed and firm sp that the mouth won’t open, but this method seldom works and the devices leave marks on the face.
Chin-Rest Method
Most elderly people have no teeth, making this method useless from the start. This method consists of fastening a strong ligature or fishing line around one of the upper incisors and allowing the free end to hand loose. A similar ligature is placed around the corresponding lower incisor and then both loose ends of the ligature are tied together. The biggest fault is that most people have an overbite.
Dental Tie Method
This is the muscle of mastication; the grinding of the mandible against the maxilla.
Masseter Muscle
Injection of high index cavity fluid, via small syringe, into the masseter muscles (loacted at the rear of the mouth behind the teeth). The mandible is then put in a closed position until the muscles firm. A problem that may arise is a circular burn mark in the cheek from the cavity fluid. This method seldom works.
Hypodermically Injecting the Masseter Muscles
- This method is unprofessional
- This is the predecessor of the needle injector method.
- One carpet/upholesterer’s tack is driven with a light tack hammer into the mandible between the roots of the teeth. The second tack is driven into the maxilla between the roots of the teeth, the mandible is positioned and with a fine suture, the two tacks are tied together. After ligation, the tack heads are counter-sunk with a punch.
The Tack and Thread Method
A controversial method deemed unprofessional by many embalmers, but effect as a mouth closure method. It is the application of the adhesive to top or bottom teeth. The mandible is positioned, the adhesive sets in fifteen minutes and the mouth is permanently closed. The method is useless if the deceased has no teeth. Same problem as a dental tie. Applied with a caulking gun in conjunction with replaceable adhesive tubes.
Drywall Adhesive- Liquid Nail
- Muscular Suture
- Mandibular Suture
- Needle injector or tack gun method
- Wire through the bones
Relible Methods of Mouth Closure
You suture the mentalis muscle of the chin to the septum of the nose.
- Half moon needle and single, find strand of suture.
- Needle is passed through the mentalis muscle just inferior to the frenulum in as wide of an arc as possible (about 1 inch)
- Done on the opposite side as the viewing side
Muscular Suture
Suturing around the mandible and through the septum of the nose.
- J-shaped needle and single strand suture.
- Needle is passed behind the gum through the floor of the mouth aimed to a point lateral to the chin, then reinserted through the same hole in front of the gum, aiming for the nasal passage. (then through the septum)
- A small dab of wax may be necessary to cover the hole in the chin.
Mandibular Suture
This is the best method for false teeth (dentures) because it helps hold the teeth in place when you tie the bottom plate to the gum.
Mandibular Suture
Packing the mouth with cotton between the dentures.
Another way to help keep dentures in place
The attachment of the mandible to the maxilla by wires attached to barbs and inserted mechanically into the gums.
- Injector is held at a right angle to a central point near the frenulum of the mandible and maxilla, a barb is injected at the roots of the teeth into the gums.
The needle injector or tack gun method
Used only in cases with disease or trauma involving the head. A small hole is bored through both the mandible and maxilla at the root of the teeth. A wire is then passed through the holes, the mandible is positioned ad the wires are twisted together.
- Good method for suicide and gun shot wounds.
- A dremel with a narrow bit is most effective.
Wire Through the Bones
- To tie the suture or wire from the mandible too close to the maxilla when there is no teeth, causing the lips to pucker and make a “fish mouth.”
- Not suturing or tying the ligature close enough
Most Common Mistakes in Mouth Closure
- Weakest- Needle Injector
- Strongest- Mandibular suture
- In-between- Muscular Suture
Strength of Mouth Closures
Has no puckering problems or bows to worry about.
Needle Injector Method
Never glue, tie or wire a body’s or younge child’s mouth shit because a child’s mouth is never closed, even in sleep, and it is not natural to effect a complete lip closure. After injection, apply a thin coat of petroleum jelly or stay cream to the lips, bring them together with your fingers and release them. They will part naturally.
Baby Cases
Method of mouth closure in which a suture is passed through the septum of the nose and around the mandible.
Mandibular Suture
Method of mouth closure in which a suture is passed through the septum of the nose and through the mentalis muscle of the chin.
Musculature Suture
A mechanical device used to impel specifically designed metal pins into bone.
Needle Injector
A preparation aid used in mouth closure. It is inserted into a needle injector and forced into the mandible and maxilla.
Injector Needle
A fold of mucous membrane that connects the gums to the inner lining of the lip.
Frenulum
Preparation room materials used on cases where the lips and/or eyelids are difficult to close properly.
Lip sealer and Lip cement
Will require no special adjustment since they position automatically when the mandible is brought into place.
- Most people have an overbite.
Normal Teeth
Fill in the gaps with dry, striated cotton which is used especially for posing features. DO not use drug store cotton and also beware of batting cotton because it may smolder when it comes into contact with glue (cyanide gas).
Where there is a Single Tooth or Groups of Teeth Missing
This is the facial feature and expression that is the most prominent in death.
Mouth
This is the facial feature most prominent in life.
Eyes
Should always be cleaned before they are inserted into the mouth. Always get them from the hospital, family or nursing home when making the removal. Using them will reduce the margin of error by 90%, unless they are loose.
Dentures
The shape of positioned lips.
Classical Hunting Bow
Always remember to do this and fill out the cheeks slightly with cotton. This will give the deceased a younger, healthier appearance.
Raise the Corners of the Mouth
Over use of cotton, causing the features to appear swollen.
One of the Most Common Mistakes of the Novice Embalmer
- Using forceps and an aneurysm hook, carefully insert small amounts of cotton where necessary to effect a proper lip closure.
- Apply stay cream liberally over the cotton and behind the lips, this will prevent dehydration and keep the lips together.
Procedure When Posing Lips
Such a procedure will cause distortion and severe wrinkling in facial areas especially the cheeks and eye sockets. Trying to position already embalmed facial tissue will lead to disaster.
- Autopsied cases are an exception
- This includes preinjection
Never Pose the Features After Embalming
These methods are for lazy embalmers and in many instances cause distortions of the facial features.
- Caulking gun, pliable waxes, clay, incision putty, etc.
- Mouth formers (when used alone), toe tags, matchbook covers, business cards
Acceptable (but not best or even professional) Methods of Positioning Lips
Embalming equipment used to inject a substance into the mouth, giving the deceased a more life-like appearance by filling out the mouth.
- Replaces the cotton technique over the teeth.
Poze Injector
Problem if the lips will not stay closed.
Lip Closure Method
- Wet cotton strip method
- Intradermal suture method
- Cohesive method
- Treatment for dehydrated lips plus the cohesive method
- Straight pin method
Proper Methods of Lip Closure in Older Children and Adults
Place a saturated, cotton strip above the upper lip and under the lower lip, exerting a downward and upward pressure to keep the lips closed. Use a full firming arterial fluid to inject the remains; and after the tissue has firmed, remove the strips.
Wet Cotton Strip Method
When the lips are sutured along the inner margin behind the weather line. Use a small half-moon needle and a fine suture to make lip closure. It is considered a poor method because when the suture is drawn, the lips may pucker and gap, requiring a filler wax.
Intradermal Suture Method (Hidden Stitch Method)
When you use any of the imported glues to effet the lip closure.
- Be sure the lips are dry and free of any massage cream, stay cream, or vaseline. (glue will not adhere to an oily surface).
- Always glue the lips to the teeth; never glue lip to lip. (lips will flatten and cobweb effect will form on the line of closure).
- Imported glue (Japan) will cause batting gotton to smolder, cyanoacrylate-ethlene (cyanide gas), a key chemical found in the glue.
Cohesive Method
A common problem and is faced by man embalmers today due to cases dead for many hours or days (postmortem interval).
- Hypodermic needle w/ tissue builder or massage cream - only after arterial injection.
- Inject at two separate points, one at each corner of the mouth. (bottom lip first)
- Stay cream or adhesive to hold lips in place and prevent further dehydration.
Treatment for Dehydrated Lips Plus the Cohesive Method
A common mistake made when treating dehydrated lips, causes the lips to swell.
Overuse of Tissue Builder
Two straight pins attach lips to gums:
The frenulums are cut with a scalpel, the lips are stretched and positioned, and then you use two straight pins. one is inserted into the philtrum of the top lip and the second is inserted in the medial plane of the lower lip. After embalming is completed and lips are closed, remove both straight pins and apply a cohesive.
Straight Pin Method
You cut the two frenulums of both lips with a scalpel, stretch and position the lips, and use either the cohesive method or the straight pin method or the wet strips of cotton method.
Minor Dental Prognathism
It is impossible to effect a lip closure. Even if the lips could be stretched and the frenulums cut, the appearance would be unnatural because the protruding teeth are a natural characteristic of that individual and should be preserved in death.
Major Dental Prognathism
- Brush teeth with an abrasive chlorinated Ajax-type cleanser. Then rinse, dry and apply a thin coat of clear fingernail polish to the teeth.
- Use a needle injector gun to effect the mouth closure. In doing this, use 4 wires, two on each side of the gums. Be sure wires are tight and not visible. Also can use drywall adhesive on back of teeth.
- Position the lips showing the same number of teeth that showed during life; then glue the lips to the teeth.
Treating Major Dental Prognathism
- Realign the teeth using a light tack hammer to drive the teeth back into the gums.
- Extract the teeth and pose the features.
- Most embalmers consider both of these techniques unprofessional
Only After Obtaining Permission From the PRD
American Board of Funeral Service Education
- Create cirriculum for schools
- Accredit mortuary school
ABFSE
International Conference of Funeral Service Examining Board
- Write/Create national board exam
- Administer the national board exam
CFSEB (ICFSEB)
Projection of the jaw or jaws that may cause problems with mouth closure and alignment of the teeth.
Prognathism
- Do not manipulate the eyelids anymore than necessary
- Cleanse the entire area with a suitable non-astringent disinfectant
- Put cream under the eyelids
- Placement of the eyecaps
- Location of the line of closure
- Eyelids should abut and never be overlapped
Procedure- Closing the Eye
To do so would cause tissue burning resulting in severe desiccation marks and stain.
Do not Manipulate the Eyelids Anymore than Necessary
Including eyelashes and corners of the eye.
Cleanse the entire area with a suitable non-astringent disinfectant
May effect better closure and protect against dehydration.
Putting cream under the eyelids
Utilize an aneurysm hook or aneurysm needle and blunt forcep to position them.
Placement of the eyecaps
In the inferior 1/3 of the eyesocket. The top lid should occupy 2/3 of the orbit of the eye and the bottom lid should occupy 1/3 of the orbit of the eye.
- The orbit of the eye is almond shaped.
Line of Eye Closure
Overlapped eyelids cause the deceased to appear swollen and distorted; the lower eyelash disappears completely.
Eye lids should abut and never overlap
- Sunken eyes
- Types of eyecaps
- Adhesives
- There are two types of eye enucleation
Special Considerations of The Eye
Usually, but not always, is a result of postmortem dehydration resulting in “cupping” of the eyeball or a flattening out of the eyeball due to postmortem dehydration.
Sunken Eyes
- Nonabsorbent cotton carefully placed between the eyeball and behind the eyecap. The eyecap is raised up to normal position by the nonabsorbent cotton.
- Injection with a narrow gague syringe needle either massage cream or tissue builder behind the eyeball- posterior orbit of the eye.
- Injection with a narrow gague syringe needle either massage cream or tissue builder directly into the eyeball. (most embalmers prefer this over injection behind the eyeball).
3 Methods to Solve Sunken Eyes
An aneurysm hook or needle to hold the eyelids back while inserting the proper size eyecap with a blunt tip or plain tip forcep. Gently placed into the eyes.
Method of Applying Eyecaps
One drop of any imported glue on the center of the eyecap will be sufficient to hold the lids in place; be careful not to get glue in eyelashes.
Adhesive
- Entire Globe
- Corneal Sclera Button Excision Only
Two Types of Eye Enucleation
Eye enucleation restoration should be done only after arterial embalming because of leakage of blood, bodily fluid and excess arterial fluid. Swelling will result in the eye sockets if eye enucleation restoration is done prior to arterial injection. Blood, arterial fluid and bodily fluids have no way to escape.
Corneal Sclera Button Excision Only
Only done after embalming.
- Cauterize the eye socket - collidion base jelly or liquid. (searine)
- Insert prosthesis- mortuary putty or wax shaped into spheres or cotton balls (batting cotton)
- Most prefer cotton balls, all same size, from the drug store.
- Eyecap is placed under the lid on top of the prosthesis.
- Use of adhesives is recommended.
Entire Globe
Only after embalming
- Aspirate the entire center of the eyeball- remove everything.
- Do not pull, tear, cut, rip or so remove loose tissue from the eye or eye socket; this will cause more leakage problems.
- Apply incision sealer powder or putty into the now hollow eyeball- insert cotton ball then eyecaps- and glue.
- Be sure both eyes are the same size.
Corneal Sclero Button Excision Only
- Edema
- Trauma
- A poor eye closure procedure
- Too great a rate of flow or injection pressure
- Poorly done eye enucleation by eye bank
- Poorly done eye enucleation restoration by the embalmer
Causes of a puffed or swollen eye (List Question)
- Cold water packs
- Cavity fluid pack
- Eye weights
- Electric spatula (tissue reducer)
- Narrow hypodermic needle
- Eyecaps dipped in preservative topical jelly
Treatments for the puffed or swollen eye
The use of ____ ____ ____ during and after injection- it is recommended that you leave the packs on for 12-24 hours.
Cold Water Packs
If the eye is swollen and discolored, it is recommended that you use a bleaching fluid.
Cavity Fluid Pack
Rare. Lead eye weights or little sand bags made from baby socks are placed on the eyes to reduce the swelling.
Eye Weights
In using one of these items, you need to use a large amount of massage cream or cooking grease to avoid burning the tissue. Put the cream or grease over the eye. (Never lay this on unprotected tissue and be sure the eyecap is out). Use quick strokes on the area until it is reduced to its normal size.
Electric Spatula (Tissue Reducer)
Dip _____ into preservative topical jelly prior to insertion - also coat eyelids.
Eyecaps
To touch or contact as with the tarsal plates of the closed eyelids.
Abut
Mucous membrane that lines the eyelid and covers the white portion of the eye.
Conjunctiva
Transparent part of the tunic of the eyeball that covers the iris and pupil and admits light into the interior.
Cornea
That portion of the cornea recovered for transplantation. The cornea and sclera considered together comprising the tunica fibrosa or fibrous coat of the eye.
Corneal Sclera Button
The white part of the eye.
Sclera
Removal of the eye for tissue transplantation, research and education.
Eye Enucleation
Extravasation of blood as a result of eye enucleation.
Eye Enucleation Discoloration
A thin plastic dome-shaped disk used to restore contour just beneath the eyelids. An aid in eye closure.
Eyecap
Method of eye closure in which the upper lid is placed on top of the lower lid.
Eyelid Overlap (Outdated)
Inner lining of the eye that recieves the images formed by the lens and transmits those images to the brain through the optic nerve.
Retina
