This article will complete embalming of the facial features and proper positioning of the head and shoulders. It will also begin the embalming of the primary blood vessels for vascular injection.

  The nose after death usually has a pinched appearance. Insert a small piece of cotton saturated with Mouth Fix or MF at the completion of the embalming injection. A roll of cotton saturated with Mouth Fix should be placed under the ear lobes for stabilization during the embalming procedure. This allows for the earrings visualization when the body is casketed. Ear lobes which are folded under are not natural.

  Once all the features have been established, the practitioner may feel it necessary to additionally fill out the cheeks to produce natural facial contours. This can be done with cotton or preferably MF allowing for digital adjustment during and following the embalming process. Injection of a large volume of properly formulated arterial injected at a low rate of flow allows solution to follow natural contours of the face to recreate natural and acquired facial markings. The addition of a humectants will provide a retention factor.

  Some practitioners place a thin coat of emollient cream EMC or Soft Skin over the entire face prior to embalming. If the face has not been properly cleaned, it could encase potentially dangerous pathogenic organisms. This is why the wearing of gloves while applying cosmetics is essential.

  At the completion of the feature, the body should be repositioned. Repositioning is a continual process as is concurrent analysis throughout the total embalming procedure. Certain procedures would continually change the body’s position. Final positioning would not be completed until the arterial injection begins. Even then continual adjustments will need to be made.

  Initial positioning of the body should be as close to the final positioning for casketing. The major concern being associated with the positioning of the head after the cervical vessels have been exposed if they are to be the sight of injection.

  In proper positioning of the head, the shoulders should be blocked and the head placed on an adjustable head block and the neck stretched. The head should be placed straight on the head block so as not to see into the nares. The head then should be turned to a 15 degree angle to allow for proper position when casketing. While positioning the body, special care should be given to the hands to create the natural cupped contour. This can be done be using a wad of wet cotton or preferably a half of a tennis ball placed in the palm of the hand. When the embalming is completed, the body should be blocked and positioned straight on the prep or dressing table. It is important to maintain the position of the head for naturalness. The hands should be positioned in accordance to local customs or religious affiliation         

  We will now begin dealing with primary blood vessels starting with the right common carotid artery, which is the most common artery used in embalming,

  We find this vessel has a large accompanying vein (internal jugular). The artery follows the course of the trachea and esophagus. The carotid sheath contains the common carotid artery, the internal jugular vein and the vagus nerve. The imaginary guideline for the right common carotid artery is from the sternoclavicular articulation to the angle of the jaw, ear lobe of the mastoid process (behind the ear). The incisions vary as to the practitioner.

  The medial supraclavicular lies between the clavicular and sternal attachment of the sternoclavicular muscle. This incision should be approximately 1 inch in length with the clavicle (collar bone) used as a support for cutting. The tissue is pulled slightly upward prior to making the incision. Blunt dissection exposes the carotid sheath containing the necessary vessels for injection and drainage. Some practitioners lift the whole sheath; separate the vessels and then place two ligatures on each vessel (superior and inferior) using straight forceps, the aneurism hook (needle) or a thread passer. Care must be taken not to twist the vessels. Other practitioners pick up the vein first and others the artery first. The technique is optional since all prepare the vessels for the insertion of the necessary tubes.

  Two arterial tubes are inserted in the right common carotid (one upward) superior, and one downward (inferior), for control and convenience. For maximum control, it is recommended that a drain tube be inserted into the internal jugular. This allows control of intravascular pressure and distribution. The addition of a plastic hose to the drain tube to the point of drainage provides control and a method of environmental control. The insertion of the drain tube may be difficult. If the vessel is twisted, a pair of angular forceps may be used to prepare the way for the arterial tube. Use the largest drain tube possible and if resistance occurs use a smaller size. If there is still resistance, gently lift the right shoulder when inserting the drain tube changing the direction in a circular motion.

  The supraclavicular incision is made at the middle third of the clavicle. The vessels are located toward the midline hugging the trachea. Anatomically, the trachea lies anterior to the esophagus. The trachea is made up of C shaped concentric rings of cartilage which can be identified by digital touch. Pick up the left common carotid from the incision made on the right by dissecting the tissue above the trachea or between the esophagus and the trachea. After embalming, make an incision between the concentric cartilage of the trachea and pack the trachea superiorly and inferiorly with cotton saturated with Mouth Fix. Additional injection sights for the common carotid arteries are: the parallel incision, restricted cervical, half-moon, transverse incision and flap incision. ET-10 will deal with secondary vessels.