Above-the-Neck (Oro-Facial) Anatomy for Piercers Course Focus • Overview of the anatomy we commonly pierce • Areas safe to pierce • Risky anatomy to avoid • Practical and useful hints and tips Elayne Angel: What Are My Qualifications? • I’ve been piercing professionally since the 1980s • I wrote The Piercing Bible • I’m credited with the popularity of tongue and other piercings • I’ve co-taught this course numerous times Disclaimer • I am a piercer, not a medical or dental professional Taking this course does not mean: • That I have taught you to pierce • That you have apprenticed under me • That you know all there is to know about oro-facial anatomy Betsy Reynolds • I am an oral biologist who has taught graduate and post-graduate classes in the dental sciences for over twenty years • I am not a piercer but I am an advocate for the piercing industry Overview of Topics Basic anatomy of head and mouth with piercings of: • Ear lobe • Ear Cartilage (including variations) • Eyebrow (and nearby facial placements) • Nostril • Septum • Tongue and other intra-oral placements • Lip/Labret • Cheek Anatomical Considerations • There is a network of nerves, blood vessels and lymphatic vessels throughout the head & neck • The larger of these tend to be located close together • They are also commonly situated in protected locations (behind bone, tendon, muscle, etc.) Piercing consideration: NEVER pierce behind such structures!!! • Fortunately, blood vessels and nerves tend to slide or roll when grabbed or poked at (which makes drawing blood a challenge at times) • Piercers routinely puncture the smallest and most peripheral of the vessels and nerves with no ill effect whatsoever Blood Supply to the Head and Neck Area Arteries carry blood from the heart to the tissues of the body; the blood is freshly oxygenated and bright red • The principal arteries that supply the head and neck are the Common Carotid Arteries • They run on both the right and left sides of the neck Veins carry the blood from the tissues TO the heart following the same general pathway of the arteries • They carry DE-OXYGENATED blood back to the heart Piercing consideration: Avoid the pterygoid plexus—a concentrated group of veins located behind the last upper molar Head and Face Anatomy CAVERNOUS SINUS • MANY veins of the face, particularly from the lip and nose, drain right into the brain • Because of its connections with the facial vein it is possible to get infections in the cavernous sinus from an external facial injury within the danger area of the face Piercing consideration: An infection of the cavernous sinus can go right to the brain Lymphatic System • Disease-fighting cells move about the body in the blood and in a clear, yellowish fluid called lymph • The lymphatic system is the “garbage collector” • Sucks up metabolic waste and toxins from the extracellular fluid of every organ • Lymph flows through vein-like tubes that enlarge in places to form LYMPH NODES • Lymph vessels follow the vascular system (veins and arteries) • There are more lymph glands in the head and neck that any other part of the body Piercing Considerations: • Feel (‘palpate’) for any swelling or hardness in the area of the piercing prior to the procedure • When swelling appears suddenly and is painful, it is most likely a result of injury, inflammation or infection • Some lymph node swelling post-piercing is normal (indicates the body is ‘healing’) • Inflamed but not painful lymph nodes can mean trouble (potential malignancy)— especially if the node is ‘fixed’ (non-moveable) Nerves of the Head and Neck Facial Nerve • Like lymphatic vessels, nerves ‘run’ with blood vessels throughout the body • Where there is a nerve, there will be a corresponding vein and artery • VAN = Vein, Artery, Nerve • Facial nerve allows for facial expression • The Facial nerve plays a role in taste, hearing, balance and tear production Piercing consideration: If damaged, Bell’s Palsy can result Trigeminal Nerve • The Trigeminal nerve provides sensation to all of the teeth • Carries taste fibers to the tongue • Innervates the muscles responsible for chewing and swallowing Piercing Considerations: • If a nerve is severed, loss of sensation and/or function occurs • Sometimes sensation/function returns; sometimes it does not • If a nerve is traumatized or irritated by piercing, pain, tingling, and/or numbness can occur Skin • Largest organ in body • Weighs 6-9 lbs. (3-4 kg.) • Makes up approx.16% of body weight • Comprised of layers: Dermis and Epidermis Keratinized Epithelium (Skin) Functions • Barrier to outside environment • Maintains water balance and temperature • Protects body from injury and infection • Excretes various waste substances • Sensation Strata: Skin Layers • Epidermis--epithelial outer layer • Dermis--dense fibrous connective inner layer • Subcutaneous Layer--hypodermis Piercing Considerations • Always thoroughly inspect the local anatomy before piercing • Look! Bright light (transillumination) can help • Palpate! Feel for veins, vessels, any structures you can/should avoid with Techniques and Tips for Common Above-the-Neck Piercings EAR LOBE PIERCINGS • Serious consequences (such as keloid formation) can result from ear piercings Ear Anatomy The external ear consists of the flared portion (‘auricula’ or ‘pinna’) and the external acoustic meatus (‘ear opening’) It is composed of a single thin plate of cartilage (with minimal blood supply) which is covered by skin—the ear is connected to the skull by ligaments and muscles On the surface of the ear, the skin is covered by fine hairs, sebaceous (‘oil’) glands and sweat glands The lobule (‘earlobe’) is the one part of the human auricle that normally contains NO cartilage • The lobule is a wedge of fibrous and adipose tissue (‘fat’) covered by skin • There are many normal variations to the size and shape of the earlobe There are two sets of muscles for the ear: • The extrinsic muscles (connect the ear to the skull and scalp and move the auricular as a whole) • The intrinsic muscles (extend from one part of the auricle to another) Blood vessels in the ear are usually small, though there are arteries • The anterior auricular from the superficial temporal artery on the front of the ear • The posterior auricular from the external carotid, on the back of the ear • Auricular branch from the occipital artery • There are also corresponding veins Earlobe Piercing Placement Earlobe piercings are prone to problems only when the placement is extreme • The bottom of the lobe (too little tissue) • The juncture of the earlobe and face (area of large blood vessels) Piercing considerations: • Ask your client during marking if (s)he has a particular vision for the piercing (including future stretching) • ‘Cheating’ the placement a bit higher may be helpful if future stretching is a consideration Ear Cartilage Anatomy The entire cartilage framework is fed by a thin covering membrane (‘perichondrium’)—an infection of this dense, irregular connective tissue is called ‘perichondritis’ VERY IMPORTANT: Cartilage lacks vascularity (‘blood supply’)—majorly affects healing as an adequate blood supply in an area of trauma (such as piercing sites) is extremely critical!!!!! Ear Cartilage Placement • Acceptable to pierce at the base of the helix where it joins the scapha (the flatter portion of the cartilage from which the helix curves); often, these piercings are referred to as ‘helix’ piercings but are technically scapha piercings • Piercing can pass through the helix (curled outer rim of the ear) IF it is pronounced enough • Do NOT try to sidestep the cartilage by piercing a pinch of skin close to the edge—the piercing will tent to migrate or reject; additionally, the pressure from hard cartilage from behind them pushes the jewelry out • NOTE: If a piercing is so superficial that a 6 mm (1/4 inch) diameter ring fits, the placement of the piercing is too shallow Ear Cartilage Risks • Piercings of the ear cartilage are prone to disfigurement if a serious infection develops • The cartilage can collapse, causing a “cauliflower ear” appearance • Perichondritis can cause severe damage to the ear structure if it becomes chondritis -- infection of the cartilage itself • Keloid scarring can form as late as a year after injury Ear Anatomy/Function • The pinna projects from the side of the head to collect the vibrations of air created by sound • The external acoustic meatus leads inward from the bottom of the auricular and conducts the vibrations to the inner ear Piercing consideration: Large punches or stretches of the cartilage can result in diminished function (hearing loss) unless plugs (versus eyelets) are worn Ear Cartilage Piercing Procedure • Piercing needle: up-gauge (vs. same-gauge) • Intended to promote the comfort and healing of the piercing by allowing your body to form a small cushion of scar tissue • The jewelry does not press directly against the dense cartilage • The piercing may bleed a little more when it is performed with a larger needle Cartilage Tips (For Ear and Nostril Cartilage) Compression Technique • To avoid hypertrophic scarring during healing • As soon as the piercing is done and the jewelry in place, use sterile gauze or cotton swabs to apply firm pressure on both sides of the piercing • For fifteen seconds to a minute, as if attempting to stop bleeding (even if no blood is present) • Reattaching the surface tissue to the cartilage underneath helps reduce the likelihood of localized ear cartilage and nostril bumps Eyebrow Anatomy • Eyebrow piercings are sometimes