Craniomaxillofacial Surgery and the Legacy of Joseph S. Gruss

Craniomaxillofacial (CMF) surgery is unique, not only in the breadth and depth of clinical problems treated by practitioners but also because of the inter- and multidisciplinary nature of the care required for patients with congenital, post-ablative, and post-traumatic facial differences. The evolutionary trajectory of the specialty is not a solitary line, but rather the concordance of multiple paths with frequent intersections between oral and maxillofacial surgery, plastic surgery, otolaryngology, ophthalmology, neurosurgery, and general surgery. This diversity of surgical backgrounds has propelled the field forward, more so than any single specialty’s contribution, as each component specialty brings an important perspective to surgical diagnosis and treatment. The field at large is unquestionably strengthened due to this synergy.

Mentorship has always been a critical part of surgical development; CMF surgery is no different in this regard. While strict apprentice-based models of education transitioned to formalized graduate medical education long ago, mentors remain critical components of professional development for surgeons. In the modern era, this form of mentorship need not be restricted to “within-program” relationships. The worldwide adoption of live (and currently virtual) instructional courses has greatly enhanced the avenues by which direct mentorship can occur.

Joseph S. Gruss, MBBCh (1945–2019), is an apex example of both of the aforementioned domains in CMF surgery: multidisciplinary thinking and effective mentorship. Dr. Gruss grew up in Johannesburg, South Africa, graduating from the University of Witwatersrand in 1969. Following medical education, he subsequently completed formal residency training in family practice, general surgery, head and neck surgery, and plastic surgery. This distinctive training, broad in both clinical medicine and technical surgery, prepared Gruss to tackle the most challenging surgical problems, many of which lay outside the defined boundaries of any single specialty area. With his broad training, he felt comfortable in the intersection of complex maxillofacial, head and neck, and cranial surgery. Universally recognized as a superb surgeon, capable of tackling the most difficult problems with apparent ease, Dr. Gruss was, most importantly, an outstanding clinician with a deeply empathic nature that was a consistent comfort to patients and their families.

Dr. Gruss was known for his great candor with regard to outcomes and his persistence in challenging surgical dogma. In conjunction with his close friend, Dr. Paul Manson, Gruss’ contribution to the evolution of rigid fixation for management of CMF injuries is well known.[1] Although contemporary surgeons may consider these concepts standard practice, it was only through persistence, honest assessment of outcomes, and collaboration that these principles were established as safe and effective for patients. Similarly, Dr. Gruss’ efforts in the management of lambdoid craniosynostosis and critical distinctions from positional molding, while perhaps less well-known, dramatically changed surgical paradigms for cranial vault reconstruction in patients with posterior plagiocephaly, preventing unnecessary surgery.[2] After nearly 4 decades of clinical practice, Gruss identified these 2 areas as his most meaningful contributions to the practice of CMF surgery. Historical perspectives for both of these clinical areas are featured later in this issue.

Dr. Gruss trained over 100 residents and 60 craniofacial surgical fellows, as well as countless surgeons through educational programs sponsored by the community of CMF organizations.[3] A dedicated teacher, Dr. Gruss would frequently remark about the insights trainees brought to clinical care; one of his most critical “lessons learned” was to listen to residents, as they frequently have good ideas. For all who had the opportunity to work under his tutelage, it was apparent that Dr. Gruss had a love for teaching and a sincere respect for trainees. His devotion to trainees will continue to shape the field long into the future, as those influenced by his teaching become teachers and mentors to the next generation of CMF surgeons.

It is only by standing on the shoulders of giants that our field has advanced to its current state. While CMF surgery lost a tremendous force for change with Dr. Gruss’ passing, his legacy lives on through those he has mentored, his contributions to our understanding of complex CMF problems, and, most importantly, the innumerable lives he changed with his compassionate, thoughtful, and honest approaches to patient care.

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Richard A. Hopper, MD, MS and Srinivas M. Susarla, DMD, MD, MPH

Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine