Medical team rebuilds faces ravaged by injury and disease

Like any 17-year-old, Emily Gravenhorst follows a routine to get ready for a day of high school. She showers, styles her hair, puts on her make-up and eats breakfast. And just before she leaves the house, she puts on her right ear.

Emily Gravenhorst talks about getting a new ear from the maxillofacial prosthetics laboratory at Washington University School of Medicine in St. Louis.

That ear was created in the maxillofacial prosthetics laboratory at Washington University School of Medicine in St. Louis, where one dental specialist and one technician help patients fit back into society after disfigurement due to accident or disease.

Gravenhorst lost her ear a little more than a year ago when she was thrown through the back windshield of her car after running into a telephone pole. She also lost most of her blood, suffered bleeding in the brain and broke numerous bones in her face, back and skull.

Amazingly, Gravenhorst’s body healed almost completely, and she’s learned to accept her new ear. “I just feel lucky to be alive,” says the junior at Reitz High School in Evansville, Ind.

She says her accident changed her life in every way imaginable. “I’ve become very positive and make straight A’s,” she says. “And I live day to day.”

She’s also grateful to the laboratory that gave her a new ear.

For 27 years, W. Donald Gay, D.D.S., associate professor of otolaryngology, and maxillofacial prosthetics technician Ann Vitale have worked as a team to rebuild the faces of patients ranging from 3 to 80 years old. In a lab with beaker-lined shelves, a plaster-mixing machine and a high-speed grinder, they craft artificial ears, noses, eyes and dental devices for patients with birth defects or those who have lost part of their faces because of injury or cancer surgery.

“You really help to give people their lives back,” Vitale says. “After all surgical avenues have been explored, and surgeons have done what they can to save the patients’ lives, we do what we can to preserve their social acceptance.”

The School of Medicine’s maxillofacial prosthetics laboratory is one of approximately 150 similar prosthetics labs in the United States, most of which are affiliated with medical centers. The Washington University laboratory is unique because while most prosthetic technicians specialize in one type of prosthesis—eyes, ears, noses or dental devices—Vitale, under the supervision of Gay, makes them all.

The facial prostheses are constructed of silicone, and the goal is to make them unnoticeable to the casual observer from three to six feet away. Most are attached with a medical adhesive each morning and worn until bedtime. They normally last two to three years.

During an initial consultation, Gay, a maxillofacial prosthodontist, makes the first impression of a patient’s face. To craft an eye or an ear, he uses a reverse image of the intact portion of the face to measure for the prosthesis and then passes that information on to his technician.

Vitale joined the lab after graduating from the dental technology program at Southern Illinois University at Carbondale. Blending art with science, she creates two to three finished facial prostheses each month. The painstaking process requires her to not only understand the science of metals, acrylics and silicones, but also to spend many hours sculpting and painting.

“This is a process that’s done by tiny increments and adjustments,” Vitale says. “Every little bit of wax that I add and then may have to take off can make the difference between a patient being extremely happy or just moderately happy.”

Vitale spends hours with patients, tweaking the wax patterns for their prostheses or tinting the skin tone with her palette of paints. If she’s working on an eye prosthesis, she chooses from a large selection of prosthetic eyes to match the person’s iris color. This stock eye is then incorporated into the final prosthesis.

Vitale and Gay also must address patients’ emotional concerns. Many of the patients they see are depressed when referred to the laboratory. Those with supportive families usually adjust to their prostheses, but those without a solid support system often struggle. “They’re the ones who are the hardest to rehabilitate, because you can do everything physically and technically, but you have trouble getting through to the psyche,” Gay says.

When Vitale first met Gravenhorst, the teenager was still in early recovery but had already developed a positive attitude. Still, it was hard for her to adjust to the new ear. “When I first put it on her, it may have been one of her low points,” Vitale says. “We’d given her something that she was totally unfamiliar with, and I think she thought people were going to notice it more than not having an ear.”

But Gravenhorst called Vitale a few weeks later, just as she was starting her junior year in high school, to tell her how much she liked the ear. She’s also had the lab make her a second ear — to wear in the summer to match her tan.

“I have fun with my new ear and tell boys, well, I guess you can’t nibble on my ear now,” Gravenhorst says. “And it’s just become part of my life.”

Whenever Vitale sends a patient like Gravenhorst out of the laboratory with a new prosthesis, she feels lucky that her job is to help people feel normal again. “I’m motivated by the fact that these patients can walk down the street, and, to the casual observer, look no different than you or I.”

Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.