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The art of science

Anaplastologists put a new face
on tragedy

April 2003

by Amanda Gallagher

Life can change in the blink of an eye. It did for Lorie Navejar. But thanks to science, no one can tell. Navejar and her family planned what was supposed to be a fun outing last April. They spent the day in Sadler, Texas and ended up taking a ride on an all-terrain vehicle (ATV). But the off-road adventure took a turn for the worse.

Navejar was riding on the back of an ATV when the vehicle hit a muddy incline and flipped over, landing on top of Navejar and the driver. The handlebar went straight into Navejar's eye . "It went directly into my right eye and went back out," Navejar said. "I covered my eye and stood up praying, ĎGod help me. God please help me.í I have never experienced pain like that and I would never wish it on anyone."

Emergency teams airlifted Lorie to a Dallas hospital. There, doctors sutured the globe of her eye. "At the time, I didnít think I was going to lose my vision. The pain was actually too bad to think about anything," Navejar said.

She returned to San Antonio and put her hopes in the Health Science Center. "But doctors said it was one of the worst cases they had ever seen as far as tissue and nerve damage," Navejar said. She lost her vision; her eye became disfigured. But her doctor, James C. MacDonald, M.D., thought sheíd find new confidence in a tiny office just down the hall.

Seeing eye to eye

An all-terrain vehicle accident cost Lorie Navejar her eye - but Health Science Center specialists were able to create a prosthetic that is surprisingly natural. "People can't tell which one is the real eye," Navejar said. "They usually guess the wrong one."

  Lorie Navejar
The artistís laboratory

Itís hard to say whether Nancy Hansenís office is an artistís studio or a medical laboratory. It is perhaps both. Hansen is an anaplastologist at the Health Science Center. She specializes in creating artificial eyes and facial and somato (fingers, toes, hands and feet) prosthetics.

"It really is an art. Each patient is like a canvas," Hansen said. "But there is a science to it: fitting the prosthesis, getting it to function, designing the retention to hold it in place and determining what materials to use and not to use."

Her tools seem relatively simple. Her office is packed with acrylic paints, thread, magnets, glue and screws. Her kiln is a microwave oven used to cure materials that are placed inside molds. She uses medical-grade silicone and acrylic plastic to create new eyes, ears, noses, cheeks and chins for patients who have suffered a severe accident, had a birth defect or lost a body part to disease. "The cases we see are split about 50/50 between trauma and disease," Hansen said.

Hansen is the only practicing anaplastologist in South Texas. She is responsible for putting a new face on patients in San Antonio and provides discounted services to patients in the Laredo area through the South Texas Border Region Health Professional Education Initiative. "The ocular prosthesis can cost anywhere from $1,200 on up, plus travel expenses if these people had to go elsewhere. We can make a prosthetic eye for a fraction of that cost," Hansen said. "We really are the only opportunity for many patients to get treatment."

Hansen does the bulk of her work in San Antonio and travels to Laredo about 12 times a year. When Navejar appeared in her office last July, Hansen knew she could help.

Perfectly normal

"I felt disfigured, not myself. I didnít feel presentable to people. I didnít want to go to a lot of places, I just wanted to stay home," Navejar said, after injuring her eye. "Dr. Sponsel suggested I see Nancy. He said the prosthesis might help the way I felt about myself."

Quality of life is an extremely important part of recovery, especially for patients who are left disfigured. "To go out in public and stand out is psychologically trying. People do look at you differently," Hansen said. But she noted that a prosthetic is much more than a cosmetic fix. "The prosthesis replaces some of the lost volume for the eye removed. In turn, it provides proper function of the eyelids and tear flow. If you donít have the prosthesis, the eyelids and lashes could turn inward, which causes irritation and infection," she said. Other craniofacial prosthetics, like noses and ears, are necessary to hold eyeglasses in place. Prosthetic chins and jaws make normal speech and chewing possible.

Hansen introduced Navejar to her partner, Xavier Guerra, a board-certified ocularist and clinical instructor in the department of prosthodontics. Guerra specializes in creating artificial eyes out of ordinary paints and plastics. The process only takes a day but the result is astonishing. "I was in awe. I couldnít believe it looked like a real eye. It looked like me again," Navejar said.

The art of science

Creating Navejarís prosthesis was a balance between fine art and modern science. Navejar posed as the artistsí model while Hansen and Guerra carefully studied her natural eye, noting the color of every fleck.

Guerra had already made an impression of Navejarís eye with a substance called alginate. "It feels cold when we inject it into the cavity of the eye, but itís not painful," Guerra said. "It only takes about two minutes to set."

Once the impression had set, Guerra cast it in wax, which became the starting point for the ocular prosthesis. After painstakingly sculpting the wax shape to fit Navejarís socket, Guerra made a mold. At the same time, Hansen began painting the iris, modeling it after Navejarís natural eye. "We match the eye by looking at the person as we paint it. Then we use thread to create the look of veins. We also tint the sclera, or the white part of the eye, to match the patientís natural eye," Hansen said.

Once the iris was painted, Hansen packed it into the mold with acrylic and cured it in the microwave. The results are pleasingly natural.

In Navejarís case, the prosthesis fits over the disfigured blind eye, enabling it to move naturally. "People canít tell which one is the real eye," Navejar said. "They usually guess the wrong one."

Hansen uses a similar process to create prosthetic fingers, cheeks and ears. "We make them out of a silicon material, which is a little more difficult to match to the color of natural skin since it isnít translucent," she said. But she can add hair, freckles and pores to the prosthesis for a natural blend.
"This is a real team effort," Hansen said. "The patient has a lot of input, and when we can, we get the entire family involved. The process is very empowering."

It enabled Navejar to get on with her life. She is studying to become a legal assistant and eventually wants to be a lawyer. "Iím a lot more cautious now. I say it once or twice a week: ĎStay alert because anything can happen,í" Navejar said. "But Iím a lot more enthused about life and Iím very grateful I have the artificial eye."

"Itís a very emotional process. Patients get emotional when they see themselves again complete, for lack of a better word," Guerra said. "And so do we."


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