Building a new face
A surgeon and two maxillofacial experts in prosthetics help a 27-year-old mother, blinded and disfigured by a shotgun blast, appear more normal to her young son.
Building a new face
Chrissy Steltz and her boyfriend, Geoffrey Dilger, wait at the office of Larry Over, DMD, MSD, a maxillofacial prosthodontist in Eugene, Ore., on July 7 as a team puts the final touches to a facial prosthesis that will cover portions of her face damaged in a 1999 shotgun accident. Steltz and Dilger, who also was blinded as a teenager, have been together for eight years. They met at a summer program hosted by the Oregon Commission for the Blind. "We became good friends, and after the program we started dating. It was completely unexpected," said Steltz, now 27.
Building a new face
To help with planning for Steltz's facial prosthesis, the medical team used a model of her skull made from x-rays taken shortly after her injury. The shotgun blast blew a trench across her face, taking out her nose and left eye completely, as well as portions of her right eye. "It's unusual to have this kind of wound and still have the patient survive," said Eric Dierks, MD, DMD, a maxillofacial surgeon at Legacy Emanuel Medical Center in Portland, Ore. "This is about as bad and penetrating as it gets."
Building a new face
Dr. Dierks examined x-rays of Steltz as she underwent reconstructive surgery in September 2009. The nearly five-hour surgery was the first step in preparing Steltz's face for a prosthesis. Because her injuries were so extensive, "tissue reconstruction really was not an option," he said.
Building a new face
Steltz's injuries required multiple surgeries. During a September 2009 surgery, Dr. Dierks removed the remains of Steltz's right eye and reopened her sinuses, which were closed off in an earlier fibula bone graft. Injured in 1999, Steltz had spent years breathing through her mouth. The surgery would allow her to breathe out of her new nose once the facial prosthesis was completed. During a later surgery in February 2010, Dr. Dierks placed eight titanium implants into the bones around where Steltz's eyes used to be. Magnetic tips were then placed on the implants to correspond with thin magnets imbedded in the prosthesis. This makes it easier for Steltz to put the prosthesis on and take it off.
Building a new face
Dr. Dierks visits Steltz in her room at Legacy Emanuel Medical Center the day after the first reconstructive surgery. Dr. Dierks said Steltz is an ideal patient. She is always upbeat and has realistic expectations. "She is a remarkable young woman," he said. "The question is, where will she go from here?"
Building a new face
Maxillofacial prosthodontist Over and David Trainer, a maxillofacial prosthetist from Naples, Fla., used old photographs of Steltz to guide design of her facial prosthesis. They wanted it to look as much like her original face as possible, only older to match her age. Steltz was 16 when she was injured. "We replicated a photo we had of her when she was 15," Over said. "It gave us the shape of her nose and the position of her eyes. It was all we had to go on. Everything else was destroyed."
Building a new face
Trainer and Over used strips of wax to shape the missing portions of Steltz's face to serve as the master for her facial prosthesis. They started by placing the acrylic resin eyes into the wax, carefully positioning them to make them as lifelike as possible. In setting the gaze, Trainer, who has been making facial prostheses for nearly 30 years, said he tried to reflect the natural asymmetry that all people have. "Human beings, we're not exact on both sides of the body," he said.
Building a new face
The completed wax master for Steltz's facial prosthesis sits on a plaster base, ready for the next phase of construction. To make it final, the base was covered with a second plaster piece cast to match the surface of the wax master. The two-piece mold was filled with silicone, which was cured at 200 degrees to make the final prosthesis. Most facial prostheses replace a single missing feature. A prosthesis with two eyes and a nose like Steltz's is considered rare.
Building a new face
Trainer examined Steltz's unfinished facial prosthesis on July 7. The silicone prosthesis had just been cured. The next step was to put on eyelashes and paint it to match her natural skin tones. Steltz said she's eternally grateful to Dr. Dierks, Trainer and Over, who all volunteered their services to make her prosthesis. A prosthesis like Steltz's typically would cost about $25,000. "I was blessed to have all of these doctors working for me," Steltz said. "There really are little angels floating around."
Building a new face
The completed prosthesis weighs about 44 grams and has thin magnets imbedded in it that allow it to snap easily into corresponding implants in Steltz's facial bones. Trainer used oil-based paints to color the prosthesis, adding details such as slight coloration resembling veins under the skin to make it more lifelike. "This is where art joins with medicine and dentistry," Dr. Dierks said. Trainer said family members usually offer feedback during the design process, but in Steltz's case they weren't shown the prosthesis until it was finished. "Because of the whole situation, her family wasn't allowed to see the work in process. I had to rely on other people in the office," he said. "Until the family actually sees what it looks like, it's always kind of a tense moment, but when they say 'Oh, ah, yeah,' I'm happy."
Building a new face
Steltz got her new prosthetic face on July 8, but she waited until she was home to show her 1-year-old son, Geoffrey Dilger Jr. She said he had "a huge smile from ear to ear" when he first saw it, but -- in typical child fashion -- was quickly distracted by the family cat. Steltz said she hopes others can learn from her experiences. "Just because an unfortunate event happens in your life, it doesn't mean that your life is over. My life has turned out pretty splendid," she said.
ADDITIONAL INFORMATION
Posted with the Aug. 2, 2010 issue - Accompanying article: Medical team gives Oregon woman a new face
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