Doctor rebuilds faces — and patients' lives

The mirror said everything.

The beautiful woman she had once been was gone, along with 80 percent of her facial bones. Her ability to speak, to eat without a gastrointestinal tube, the hearing in one ear and the sight in one eye — all gone.

After seven years of violence, in 2004 Suzy Q Karuzzo's husband held a gun beneath her jaw and pulled the trigger. He was convicted of attempted manslaughter and served three years in prison.

Karuzzo got life.

That day at Seattle's Harborview Medical Center, when she confronted her image for the first time, she couldn't imagine walking down the street without horrifying people. The bullet had split her face into two halves.

Karuzzo wanted to die. But Dr. Joseph Gruss believed her face and life could be rebuilt.

Gruss, chief of craniofacial, plastic and reconstructive surgery at Seattle Children's hospital, had long established himself as one of medicine's most esteemed craniofacial surgeons, one whose reputation drew patients from all over the world. He pioneered methods of facial reconstruction to repair damage from gunshot wounds and correct cleft palates in children.

When then-3-year-old Muhammed "Hamoody" Jauda was shot in the face by Sunni insurgents in his native Iraq, it was Gruss who painstakingly coaxed a human face from scar tissue after the blind boy was brought to Seattle. Hamoody, who has been granted asylum and is living with a Snohomish couple, now has a future he never would've had in Iraq.

As Karuzzo lay in Harborview's intensive-care unit, Gruss immediately began reconstructive surgery on her face before the scar tissue had a chance to shrink.

Then he encouraged her to go back to school and see a psychologist to help her cope. "He reminded me that God had made me perfect,' Karuzzo said.

From rejected to recruited

Gruss, 63, grew up in Johannesburg, South Africa, and started his medical career in family practice, which he loved because it allowed him to follow the development of children and their families for years.

He would later learn that craniofacial surgery requires the same extended contact with patients. "I tell medical students it's the next-best thing" to family practice, Gruss said.

Gruss moved to England in the late 1960s and took a job at London's Great Ormond Street Hospital for Children, known for pioneering research in children's medical care.

While there he worked with Dr. Paul Tessier, regarded as the father of craniofacial surgery, who was famous for surgically separating the eye sockets and face from the base of the skull by making bone cuts inside the cranium, a technique still used today to fix severe facial deformities.

In 1973, Gruss moved to Toronto and took a job at Sunnybrook Medical Centre at the University of Toronto.

In Canada, as well as in the U.S., it was then becoming common for fire-department medics to respond to the scene of accidents. As a result, more people were surviving accidents that previously would have killed them. Yet they were left with horrific facial injuries, and there were few surgeons with the skills to help them.

Using Tessier's still-radical techniques, Gruss did countless surgeries by peeling back all the facial tissue, then splitting the bones and moving them around before repairing the soft tissue. He likens it to building the structure of a house before putting on the roof.

Gruss also theorized that results could be improved if surgery was done as quickly as possible, grafting the patient's own bone into the damaged area before scar tissue formed.

He was rebuked. Other doctors not only refused to use his techniques but advised those Gruss was teaching not to listen to him. His papers were initially rejected by the medical journals.

"It was contrary to all the textbooks and I got severely criticized," he said. "I was just a young doctor and it was very hard for me."

Inspired by a German surgeon's experimental use of tiny metal screws to hold bones together, Gruss became the first North American surgeon to use them in craniofacial surgery. It was another step toward repairing shattered bones.

In 1991, Seattle Children's recruited Gruss, who saw the opportunity to start a craniofacial program, the first of its kind here. When he and his wife, Eve, arrived he found an endless supply of young patients with horrific birth defects. Their families had been told there was nothing that could be done for them.

"There were hundreds and hundreds of kids who had never been operated on. Kids who were 10 to 12 years old."

Some had eyes on the side of their head, two noses, a face flat as a lollipop.

"They had saved all these patients for me," he said.

He in turn recruited other surgeons, including Dr. Michael Cunningham, now the medical director for the Craniofacial Center at Children's.

"He operated for years on children who were much older," Cunningham said. "He got a lot of attention in the community."

And because his surgical techniques were, at the time, more radical than was commonly practiced, other physicians again questioned his judgment.

"New ideas are hard to get accepted in the medical community," he said. "I've always tried to look for solutions and take on things others don't want to take on."

Gruss' idea of "cutting the face in half and bringing it together" was very novel, Cunningham said.

It's risky and complex, but it's now a common technique taught to other surgeons who say Gruss has changed the path of their medical careers.

"Dr. Gruss is an amazing combination of surgical wisdom, compassion, and courage. There are few craniofacial problems that he will not tackle and fewer yet that he cannot correct," Cunningham said.

"He is a great mentor," said Dr. Richard Hopper, director of craniofacial surgery at the hospital. Under Gruss's guidance, the craniofacial unit began to incorporate 13 other specialties, including ear, nose and throat specialists, opthalmalogical surgeons, speech therapists, neurologists and psychologists.

In the mid-1990s, Gruss again fought the national medical establishment when he challenged the increase in cranial surgeries performed in infants following the American Academy of Pediatrics advisory that babies were safer from Sudden Infant Death Syndrome if they slept on their backs.

But babies that slept on their backs ended up with heads flattened in the back and often that was misdiagnosed as craniosynostosis, a serious condition in which the bones of the skull fuse prematurely, limiting brain growth. It resulted in countless unnecessary surgeries, Gruss said.

Gruss and his colleagues published an award-winning paper that ended the practice.

"Our group stopped it. We showed what people were operating on wasn't legitimate," he said.

A boy's life-threatening tumor

In a small town north of Milan, Italy, a large extended family of aunts and uncles waited for the birth of a baby boy. When Edoardo Borleri came into the world, his mother and father knew immediately something was wrong. On the infant's neck was a tumor. Even though it was benign, it threatened to block the baby's ability to breathe.

Surgeons in Italy could remove part of it but not all, said his aunt Guiseppina Ferraro. The only hope of saving the baby's life, doctors told them, was to send him to Gruss in Seattle. Edoardo's five aunts and three uncles, grandparents and their town raised the money.

"The surgery itself is extremely challenging and potentially dangerous," Gruss said. The tumor had wrapped itself around all the vital structures in the face, neck and chest such as the carotid artery; the facial nerve that is responsible for movement; and the great vessels in the upper chest.

"If these structures are inadvertently damaged on the operating table, the child could die."

Gruss had to dissect the tumor from the face and facial nerve and areas in the neck where it was threatening to block Edoardo's breathing. Then Gruss had to preserve the nerves and arteries until he relocated them to the place they were supposed to be.

After 12 hours of surgery, the Boleri family got their wish. Today, Edoardo is 2, rides his bike, plays with his sister and loves visiting his grandparents. Only a scar remains to tell of his ordeal. In early October, while he was lecturing in Italy, Gruss was a guest at a Boleri family dinner.

As Ferraro said: "Because he makes a miracle for us, he's a special person."

At a medical conference in Chicago not long ago, Gruss tackled his latest concern — the care for wounded American soldiers in Iraq.

With effective body armor, those who survive wounds often have injuries to their limbs or faces. Restoring soldiers to normal appearance is easiest if they receive craniofacial surgery immediately, Gruss said. As it is, soldiers are stabilized in Iraq and valuable time passes before they are sent on to a stateside hospital where craniofacial surgery can begin.

"Unfortunately, even though I have published these techniques and have lectured all over the world about these techniques for more than 25 years, it is still common to delay the repair of facial gunshot injuries," he said.

He points to Karuzzo with satisfaction.

Many surgeries later, she looks close to normal, he said.

Karuzzo, now 32, admires Gruss "not only as a doctor but as a human being," she said.

"My face will never be the same, but it is a blessing to know that there are people who don't give up when helping others less fortunate," she said.

Karuzzo now has the life she never thought she would after she was shot and left for dead. She is remarried, to a man she met at church, and lives in a quiet rural community where she's a billing clerk. They are expecting their first child.

She and her husband have a special first name in mind: Joseph, after the man who gave Karuzzo a new face and a new life.

Nancy Bartley: 206-464-8522 or nbartley@seattletimes.com