The face of inspiration

May 14th, 2013

face-titleBilly Crawford takes a long, hard look in the mirror and smiles beneath the “Tom Selleck” mustache that rests above the upper lip of his new face.

It’s mid-December 2012, and he has been without facial features for two and a half years, since a fungal infection destroyed his soft tissues down to the bone.

Seated in an exam room of the Center for Maxillofacial Prosthodontics at Texas A&M University Baylor College of Dentistry, he deftly practices snapping the magnets of his silicone prosthesis onto the nine titanium implants anchored to bones in his forehead and cheeks.

“I haven’t had a nose for so long, it will take me a little while to get used to it,” he jokes. “But it’s going to be a great adjustment. This is the best Christmas gift I could ever receive. It’s perfect; a lot better than I ever imagined.”

The need for a new face is just one of many hurdles crossed by this inconceivably resilient, unassuming 61-year-old resident of Lockesburg, Ark., a rural town with a population of 750 in the southwest corner of the state.

It’s hard to fathom the difficulties Crawford has faced over the past 20 years: cancer treatments, open-heart surgery, life-threatening bacterial infections, countless other surgeries – and then Mucormycosis.

This medical condition is caused by fungi of the genus “Mucor,” which invaded Crawford’s facial tissues after chemotherapy left his white blood count so low his immune system couldn’t protect him. At one point in May 2010, he was told he had two days to live.

Suzanne Verma, assistant professor in the Department of Oral and Maxillofacial Surgery, is Crawford’s anaplastologist, responsible for creating his prosthesis and invaluable in his multidisciplinary care.

“This has definitely been the most challenging and rewarding prosthetic restoration I have done in my career,” Verma says. “Mr. Crawford is an inspiration, and his positive attitude helped make his treatment a success.”

face-1Verma painstakingly crafted the prosthesis over a two-month period – down to the tiniest hand-painted vein, with a mustache she sewed using Crawford’s own hair. The prosthesis features hand-sculpted wrinkles, eyelids and upper lip, realistic eyebrows and a skin tone requiring 16 different colors painted into the mold layer by layer.

Equally intricate was the full face impression taken at the outset of this final stage; time consuming but vital, the impression provided a permanent cast of Crawford’s implant sites. Verma’s high-tech sculpting and modeling of his new face were enhanced by digitally manipulating CT scan data from scans taken of his face before and after the fungal infection.

Many months before prosthesis delivery, technologically sophisticated preoperative planning using CT data and simulation software prepared the team for navigational surgery – or “GPS in the OR”–enabling precise craniofacial implant placement. This was followed by several months of healing to wait for the titanium implants to integrate with the surrounding bone.

Dr. Robert Schow, professor of oral and maxillofacial surgery, undertook Crawford’s implant surgery with assistance from two former TAMBCD oral and maxillofacial surgery residents, Drs. Rob Fuentes and Ryan Womack. The patient made an impact on this longtime faculty member.

“The best thing of all is the patient’s attitude and his family’s support, both of which are incredible,” Schow says. “Despite unfortunate circumstances he kept his humor and is a positive thinker. He and his wife ask good questions and make sure they understand; they’ve been wonderful.”

The sheer scope of restoring Crawford’s missing facial structures required 17 surgeries and more than a few medical specialists beyond A&M Baylor College of Dentistry. These include Randy Trawnik, board-certified ocularist with Dallas Eye Prosthetics, and Dallas physicians Dr. Carlos Raul Barcelo, plastic-craniofacial surgeon at the International Craniofacial Institute, and Dr. Jorge Corona, oculoplastic surgeon at Oculoplastic Associates of Texas. Crawford and his wife made more than 40 trips to Dallas in 18 months; 430 miles round trip each time.

“Now that I have this, man, I’m getting out there!” he says on facial-prosthesis delivery day. “I want to get back in life again. I’m going to drive to town, see my buddies. I’ve been like a shut-in.”

Lois Crawford has remained stalwart by her husband’s side on what she describes as a “long road.” She matter-of-factly describes their medical journey, only tearing up as her husband of 36 years describes what she means to him.

“I couldn’t ask for a better wife or more support,” he says. “My whole family has pulled together and grown close.

“Every morning I thank the Lord for giving me another day of life.”

Editor’s note: Billy Crawford lost his fight for life on April 10. His inspirational outlook made an indelible mark on all who came to know him.

— Carolyn Cox