Like most boys growing up in Quito, Ecuador, 15-year-old Diego Guzman learned to play soccer. He eventually won the starting goalkeeper position on his school team. But unlike most other boys, Diego saves goals with only one eye, having lost his left eye to cancer at 2 years of age.
Though his doctor made a prosthetic eye for Diego, the doctor died by the time he outgrew the prosthesis, and no one else in Ecuador could make a new one. Instead, Diego slipped a round piece of white plastic in his empty eye socket to cover the opening and endured the taunting of other children.
But through the generosity of humanitarian groups and specialists in prosthodontics at the School of Dental and Oral Surgery, Diego flew to New York in July and was fitted with a life-like orbital prosthesis and a prosthetic eye to restore his appearance. He stayed for three weeks to complete the treatment.
Diego's journey to the school's Maxillofacial Prosthetic Center began about two years ago when his mother, Lourdes Salazar, went to a Quito health clinic seeking help from a visiting American humanitarian group. There she met Maria Harrison, who was delivering aid to the clinic on behalf of Airline Ambassadors, a group of airline personnel who provide food, clothing, and medical supplies to needy regions in the United States and abroad.
Ms. Harrison arranged for Diego to meet Dr. Steven Roser, George Guttman Professor of Clinical Craniofacial Surgery, during his Healing the Children medical mission to Ecuador last April to repair cleft lips and palates. (See POV about a volunteer on that journey.) Dr. Roser recommended Diego come to Columbia to be fitted with a silicone and acrylic prosthesis.
But the family was unable to afford the trip or the treatment, so SDOS Dean Ira B. Lamster and dentists and technicians in the prosthodontic division's Maxillofacial Prosthetic Center donated their services. Healing the Children, the organization that sponsored Dr. Roser's trip, obtained free tickets from the American Airlines "Miles for Kids" program for Diego and his mother to come to New York. The Harrisons volunteered to host the family.
Others helped in any way they could. Diego's neighbors were worried the family would miss their early morning flight from Quito, so they all woke up at 2:30 a.m. to ensure the family was awake and ready to go to the airport. Diego's older brother even slept in his shoes to save time dressing.
After they arrived in New York, Diego met Dr. Robert Wright, chairman of the prosthodontic division, and Eric Asher, an artist trained in making medical prosthetics, who immediately started crafting the prosthetic eye. Diego remained calm as Mr. Asher and other prosthetists, prosthodontists, and administrators babbling in English surrounded him. He quietly sat in a dental chair for two hours making paper airplanes as the impression material Mr. Asher put in his orbit slowly solidified. "Fortunately, he's a good patient," Mrs. Salazar says.
Based on the shape of the impression, a wax model of the new prosthesis was constructed and later fine-tuned during Diego's second visit to the clinic. When all minor adjustments were finished, Mr. Asher cast the final prosthesis from an impression of the wax model. The prosthesis includes an acrylic eye surrounded by silicone eyelids and skin to replicate the skin and mass of tissue removed during the cancer surgery.
Between prosthodontic appointments, Diego had a dental examination and received a root canal, courtesy of the endodontics division, and a restoration due to caries. He received glasses from the P&S ophthalmology department to help camouflage the prosthesis.
On the morning of the final appointment, Diego woke up nervous, wondering how he would look with the new prosthesis. When he arrived at the clinic, Mr. Asher painted the silicone to match Diego's skin and added fake eyelashes to match the long lashes in his right eyelid. Because sunlight and the adhesive used to retain the prosthesis degrade the prosthesis over time, the team made two prostheses for Diego.
With diligent care, the prosthesis may hold out until Diego is 18, when the team can assess if a more permanent prosthesis can be made. The more definitive prosthesis involves surgically placing implants in the facial bones around the eye socket to provide retention or anchorage. But the surgery can't be performed until Diego's cranial growth is complete. Dr. Wright is trying to make arrangements for Diego to return to Columbia in the future for surgery and an implant-retained prosthesis.
"We're very happy we can do this for Diego," Dr. Wright says. "The prosthesis looks good and it's necessary. It's one thing to do surgery and remove the cancer, but you have to restore the patient's appearance afterward so the patient can return to normal life."
"I feel so happy and excited and I want to say thanks to everybody that helped us and all the people here at Columbia," Diego's mother said at the last appointment. "I used to think Americans were cold, because in Ecuador we're always embracing each other. But now that I've met people here, I know that's not true."
But the most important pronouncement of the day came from Diego. When Dr. Wright asked him what he thought, he smiled and said, "I'm happy."