Picking up where we left off in ET-6, we will deal with closure of the lips in this segment.
The final consideration after the boney structures are secured is to properly position the lips. Creating a natural line of closure is essential to the overall appearance of the face.
Infants, in many cases, never close their mouths tightly if at all. A small suture can be placed laterally far enough back in the mouth not to be seen. The use of a thumb needle or full curved needle with a needle holder should be used in this type of closure due to the small working space.
The needle should be inserted through the soft alveolar process and loosely tied. Mouth fix should be applied so that the lips come together then allowed to assume a natural position during the embalming process. At birth the infant is edentulous (teeth not developed).
The edentulous body (without teeth) usually creates variable complications associated with mouth closure. The alveolar process is one in which the bed of the teeth atrophied because of extraction of the teeth leaving only the compact bone remaining. In this case, combinations of the Needle Injector, Mandible Septum Suture and the Maxillary Mandible Suture will be the method of closure.
To determine the position of the mouth in an edentulous case, one must take a measurement from the base of the nose to the root of the nose between the eyebrows. Then measure from the base of the nose to the lower portion of the mandible, secure, and create a mouth former with cardboard, course sandpaper or use Natural Expression Mouth Former. MF can be used to model the mouth and create a desired expression for naturalness.
If dentures are available, they should be removed, cleaned and disinfected. For proper closure, holes should be drilled in the dentures for passage of injector wires or placement of screws. Wiring without drilling a hole must go around the dentures which will pull them away from the boney foundation and create improper elongated appearing closure.
There are various types of prognathisms which must be addressed in the preparation of a body. To attempt to correct these may create an unnatural appearance. Photographs are important as is observing the family during the arrangement period. Many times, prognathism is a normal characteristic.
The various forms of prognathisms are Nasal, Maxillary, Alveolar, Dental and Mandibular.
If teeth are to be exposed, it is necessary to clean them with an abrasive and paint with a clear non-pigmented nail polish. It may be necessary to apply Mouth Fix while embalming to control the positioning. Light digital pressure and cotton slings will hold the lips temporarily. When embalming is complete, the lips should be secured with super glue..
In positioning the lips, (mucous membranes), you must understand what the natural configuration should be. The lips resemble a long bow creating the five natural arcs. The lips meet halfway between the nose and top of the chin. To create the natural protrusion of the upper lip, place MF between the upper lip and the maxilla. The application of pressure under the columna nasi will create the philtrum. The width is determined by dropping imaginary lines from the center of each eye which will be tangent to the ends of the lines of closure. Slight upward digital pressure using the thumb and the index finger at the corners of the mouth will recreate the angulus oris sulcus. This adds to the naturalness and is often overlooked by many practitioners.
The lips (mucus membrane) make contact posteriorly loosely at the weather line to allow for the natural distention which occurs during the embalming process. Mouth Fix is used to position the lips and control possible dehydration. Soft Skin spray may be used in addition to control vestibular dehydration. If the lips should separate after embalming, they may be secured with super glue. If the lips do not meet, you can gently stretch the upper or lower lip using a wet paper towel being careful not to squeeze. Squeezing causes distention due to injury to the cellular structure.
Another method would be to cut the frenulums then stretch the lips. Leakage would be a temporary concern but can be treated with Cadisol or in combination with Sealit of MF. Sometimes all that is necessary is to place a small roll of cotton or MF under the stretched lower lip to make the closure. The natural weight of the tissue pulling down is sometime the only problem. If the problem continues, super glue may be used in holding the lips in position.
Using an intradermal suture along the weather line is still practiced in some areas. This practice was a practical method when strong chemicals created extreme dehydration of the lips and eyes. It can still be used in extreme restorative cases.
ET-8 will deal with closure of the eyes.