RA Exam 2
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Any support or framework (beneath the surface) employed in restorative treatment
4 methods of support and attachement for the ear:
- 1. Basket-weave suture
- 2. Loop stitch suture
- 3. Bent wire armature
- 4. Wax support
Basket weave suture
*used for earsused after embalming for deep wounds or excisions, will maintain the positon of the free margins of the skin, used to provide an anchor & support for wax (wound filler)*use for nosecross stitchess hold the marginal tissue in positioncan be used to hold any armature in positionemployed in all nose reconstrution
*large woundsprimarily used before embalming to bring together the free margins of a lg. wound or cavity, serval individual loops, loops are tied loosely, and the suture is not pulled tight against the skin
is any artificial support or frame work used in a restoration, when the ear is missing an armature of firm wire (ex. a coat hanger) may be inserted under the skin, central part of the wire is bent to conform to the curvature of the ear, the ends of the wire are forced through the skin to lie flat against the underlying bones, a wire armature may also be used to form the bridge of the nose.
*aka: wax fondation, wax constructionmethod of attachement & supported by wax & constructed from wax reconstruction, all parts reconstructed are supported by wax & constructed from wax, the wax support helps to hold the artists reconstruction in place & aids in the fusion & blending of the real & the artificial parts
4 anatomical guides for positioning the ear and where ea. is located:
- 1. External auditory-
- 2. Mandiublar fossa-
- 3. Mastoid proces-
- 4. Zygomatic arch
8 methods of support and attachement for the nose:
- basket weave suture
- plaster of pairs and cotton
- cotton and liquid sealer
- wire screen
- wire armature
- cardboards armature
- cotton cylinders
- wax support
Large Cavity & Excision Restorations: treatment of large cavity and excision restorations?
it's only used if you have good ventaliation and can be done before embalming.
Large Cavity & Excision Restorations: What can be done before embalming?
- Compresses (saturated w/ autopsy gel or cavity fluid)
- Padding (saturated)
- Plugs (saturated)
- Temporary sutures (bridge or loop)
Large Cavity & Excision Restorations: What is done typically after embalming?
Additional application of cavity packs or autopsy gel, allow at least 4 hrs for tissue to dry (8 to 10 hrs is ideal) better overnight natural atmospheric drying
Large Cavity & Excision Resorations: What materials that might be used for deep filler or wounds?
waxcotton & plastercotton & sealermastic or mortuary puttyplaster of paris
Large Cavity & Excision Restorations: What sutures might be used? Before embalming? After embalming?
basket weave might be used after cavity packs. after embalming
Large Cavity & Excision Restorations: "undercutting" How it's used, what is the benefit of this procedure?
it's used after destroyed tissue is excised by triming the edge of the wound it will help hold the wax in place.
Large Cavity & Excision Restorations: How is deep filler applied?
Large Cavity & Excision Restorations: What is the surface treatment?
Waxing & Restoring the lips: 3 methods for restoring small separations?
- Cylinder method
- Filling and tooling
- Surfacing the mucous membranes
Waxing & Restoring the lips: Where is the wax placed when using the cylinder method?
against the teeth, behind the mucous membranes. then your press the mucous membranes against the wax to fill the interval.
Waxing & Restoring the lips: How is the wax used for filling and tooling?
small gaps between the mucous membranes can be corrected by filling from the front with tinted lip wax, using the spatula to cut (or draw) the line of lip closure. Finally the work can be smoothed with a brush & solvent.
Waxing & Restoring the lips: surfacing the lips
an application of a thin layer of wax to ea. mucous membrane, placing a sm. amount of wax in the palm of the hand & work the wax with spatula to make pliable, with spatula fan over the surface to create the normal convexity of the lips. all of the work can be smoothed with brush and solvent.
Waxing & Restoring the lips: the general treatment for large separations of the lips?
treat the oral cavity as open wound, cross stitches or a basket-weave will be required and made as deep as possible, model the lips over the structure making the line of closure half way between the nose and chin.
Wax: the preliminary procedures for wax restorations?
verbal or written permission needs to be granted, then make the necessary incisions or excisions after embalming. temporarily suture tissue to keep in place. tissue should be firm and dry before wax is attempted. 8 to 10 hours after embalming, set bones if necessary, remove stains and foreign matter from the skin. shave if necessary then apply heavy cream to protect the skin from drying pack deep cavities or tissue.
Wax: Do we need permission before attempting a major restoration?
yes, verbal or written permission should be granted before restoration.
Wax: The general characteristics of a wax?
oils, starch, pigments and some times a scent.
Wax: 3 types of restorative wax
- soft ("surface restorer")
- medium ("restorative" or "derma-surgery wax")
- firm ("wound filler")
Wax: the alternate names for the three types of restoratve wax
- surface restorer-soft
- restorative or derma-surgery wax-medium
- wound filler-firm
Wax: how temperature might affect restorative wax?
room temp. makes soft wax tacky and difficult to handle (better choice in this temp is medium consistency for making surface repairs and firm for features and deep cavity
Wax: how might we change or convert the consistency of restorative wax?
all waxes can be softened by manipulation in the palm. a sm. amount can be kneaded by spatula folding an stretching larger quanity's can be kneeded in the palm through the fingers and both can be softened by immersing in warm water.
Wax: the different colors of wax and how they might be used?
white (or ivory), straw (or pale yellow or natural), flesh (light, medium and dark), pink, tan, suntan, brown (light and dark), gray (warm), red (maroon) and purple.serval are used together mixing them to achieve an approximation of the subject's coloring. the first mixed was will resemble the skin the second will be lighter or darker to be mixed with the skin color.
Wax: the interaction of cosmetics and wax
- 1. applied upon wax
- 2. some can be mixed with wax
- 3. some can be applied as a concealing undercoat on a discolored and depressed area before waxing.
- (opaque cream cosmetics lend themselves to all treatement making it very rare to mix with wax.)
Wax: several methods for smoothing the wax surface
it's usually smoohted with the fingers to make your fingers glide freely, wipe clean coat them with water. (also massage cream or white petroleum jelly) using a brush across the surface helps to contour and using a wire-end instrument across the wax in contrasting directions can reduce fullness.
Wax: How can we recreate skin texture? (pores, wrinkles, furrows)
- Pores:by creating the "pore-effect" using a stipple brush simulating pores, or lintless gauze dampened and placed on the wax leaves its impression. paper hand-towel
- Furrows (shallow furrows/wrinkles)- can be drawn in with a thin, blunt-edge instrument, a piece of ligature can reproduce shallow furrows
Modeling Techniques: Development of Technique
should be developed over time. as we learn to develop our own technique we can then borrow other's to help or embelish our own technique. we can all learn from basic techniques to help us get through certain things easier and faster with the same kind of results.
Modeling Technique: Armatures
the suface of any damaged area is in variable completed with wax
Modeling Technique: Analysis before modeling
we need to analyze the feature in evry detail, anticipate the problems at hand and dtermin a plan of operation. visualize ever step and not leave anything to chance
Modeling Technique: Size, Position and Form
the size of ea. feature involves 3 dimensions; the length is vertical measurement, the width is transverse (or hoizontal) measurement, the projection is the meaasurement of the extension of any part beyond it's surroundings. confing to these limitations of measurements.
Modeling Techinique: Hands and Instruments
your hands are your best tools to smooth, form and create the brush will help with smaller or tighter areas
Modeling Technique: Rough Modeling
helps with giving you a base until you have formed the larger parts, slow and steady will help with errors which are time consuming
Modeling Technique: Smoothing a Wax Surface
smoothing can be done by hand. A thin coat of petroleum jelly or message cream on fingers or insturments (or on the wax) may help with smoothing.
Modeling Technique:Frequency of Changed Viewing
viewing your work from different angels, with different lighting, from different distances helps you to see all angles of the face along with using your own face to determin the approximate thickness of wax application
Modeling Technique: Modeling the Ear
greater accuracy in ear reconstrution is obtained by use of wax alone than by wax surfacing of an armature. Using a mirror is value if only one ear needs to be restored. Anatomical structures are more reliable for positioning an ear than a photograph.
Modeling Technique: Modeling the Nose
first establish the root of the nose, before the extent of projection of the dorsum. if the protruding lope is larger than the norm, the tip is usually higher tha the norm. pay special attention to the "hump" of a convex nose, or the "scoop" of a concave nose. dont over emphasis. if errors in the glabella and the root of the nose it will falsify the positon of the eye & may seem to alter the length of the nose.
Modeling Technique: Modeling the Mouth
with teeth present, the inside the mouth should be dried chemically, the marginal tissues sutured with a basket weave. if teeth absent, deep filler can be applied to the depth of the marginal tissues. keep speical attention to the philtrum, angulus oris eminences, angulus oris sulcus and making details for instance on the vertical lines of the lips. using a point of a straight pin or needle.
Modeling Technique: Modeling the Eye
first if the margins of the eyesocket have been mutilated or destroyed, they should be simulated and replaced before trying work on the eye. the upper margin is created by the lower part of the forehead and the same with the eyebrow.
Which is more important geometry and structure or artistry?
it's only 3/4ths geometry and structure the remaining is the artistry of the work
Where are the anterior nares positioned in regard to the base of the nose?
they are confined to the posterior 2/3rds of the base of the nose, & are oblique to each other. not extending into the protruding lobe.
How can we avoid an upturned nose?
(pug nose) make sure the bottom of the nose is at a right angle to the verticle profile of the face
How do we treat the mouth (oral cavity) when the lips are reconstructed?
it should be dried chemically, and hte marginal tissues sutured with a basket weave. if teeth are absent, deep filler may be applied to the depth of the marginal tissues
What creates the form of the classic hunting bow at the line of closure?
the lower margin of the upper mucous membrane creates the form of the line of lip closure forming the classic hunting bow
How do we reproduce the veritcle lines of the lips?
with the point of a straight pin or needle
Is it important to create the margins and bony structures of the eye? Why?
yes, the margins are influential on the appearance of the closed eye
What must be done if there is no eyeball?
treat the opening as a cavity wound before attempting restoration. use cavity packs or gel. similar to eye enucleation procdeure. make sure the eye socket is clean and dry and sealed before restoration.
Can we use a basket weave in the area of the eye?
yes if we are restoring the entire eye it's necessary in order to hold the marginal tissues in place
How do the medial and lateral canthus of the eye relate to each other?
the lateral canthus is usually inferior & posterior to the medial end (medial canthus)
Where is the greatest projection of the eye located?
medially off center
How do we describe the overall shape of the eye?
How do we describe the shape of the line of eye closure?
"almond shape" and the "gently dipping curve" of the line of closure
The details of the eye that may need to be reproduced:
the common transverse sulcus, linear sulci and optical sulci (if present)
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