Over the years, practitioners have developed many other methods for the proper securing and alignment of the mouth. Continuing below are some of the methods which can be used and would be an individual choice for the embalmer.
If an individual has a normal dentition, a dental tie can be used. Place a wire collar around the neck at the gum line of two adjacent teeth (incisors or canines) and wire together. This provides a secure closure of the maxilla and mandible allowing the practitioner to position the mouth (lips). At one time this was referred to as the canine knot because most practitioners used the canine tooth.
Probably the Septal Tie (vestibular suture) is the most commonly used by practitioners. A suture is passed through the inferior frenulum, the raphe of the lower lip and then passed through the soft septum (superior frenulum) posterior to the upper lip. This creates a puckering appearance which is sometime corrected with cotton to achieve proper contouring of the mouth. If the cotton is absorbent, it will absorb moisture and distort the mouth.
The moisture that is absorbed contains formaldehyde which leaks from the needle insertion points and creates dehydration. An alternative is to use MF cream which can be manipulated prior to, during and after the embalming process to achieve natural form.
The Vestibular Septal Suture is a modification of the Vestibular mouth closure suture which is an improvement. The suture begins with insertion of the suture needle into the raphe of the lower lip, extended superior hugging the anterior portion of the maxilla under the soft tissue and out through the anterior nares (nostril). Reinsert into the nares across the nasal spine of the maxilla out through the opposite nares (nostril). The needle is then inserted through the nostrils inferiorly hugging the maxilla under the soft tissue. A slight jerk will secure the suture.
Pull the two ends tight – this will secure the teeth – and tie a bow. The bow will allow for adjustment. In this case, you may have a distortion in the lower chin area distorting the lower lip. Other adjustments may be completed with cotton or MF cream to create naturalness.
The Triangular Suture method of closure is basically the same with a variation in securing the mandible. The lower attachment begins inferior to the canine tooth in the soft tissue and across to the other canine tooth. Secure with a bow.
Another modification – Hitch tie – secure and knot a ligature on the mandible below the right canine tooth, loop the ligature and secure a knot below the left canine and secure the loop to the upper ligature creating even pressure thus eliminating the puckering appearance.
The Mandible Suture method of closure superior attachment follows the preceding superiorly. The suture needle is inserted inferiorly, posteriorly behind the mandible (mental symphysis) out through the skin (in a wrinkle if possible). Reinsert the needle through the same hole hugging the anterior portion within the soft tissue, jerk or saw to secure under the mandible and tie a bow.
Maxillary Mandible Suture – the practitioner drills a small hole through the maxillary and mandible bones and secures with suture or wire. This is primarily used in edentulous mouths in the compact boney structure of in cases where the teeth are loose.
There are many methods to secure the mandible. Some of these are as follows – Bone Separator, Metal or Rubber Chin Support, Slaughter Chin Support, Combination of Chime Support and Head Block, Adjustable Chin Support, Hill’s Chin Rest, Masseter Muscle Hypodermic Injection, and Fusion of Teeth or Dentures – Osteofusion Powder and cyanoacrylate and mouth closures.
ET-7 will deal with different methods for the closure of the lips and the eyes.