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Victim of Turkey Stunt: The Surgery That Put Her Back Together

1/31/2005


For eight hours, doctors methodically worked as, piece by piece, they repaired woman’s smashed face
By Dionne Searcey
Staff Writer

When Victoria Ruvolo came into the care of doctors early on Nov. 13 at Stony Brook University Hospital, she looked as though someone had severely beaten her. She was unconscious and could hardly breathe on her own. And her face was literally caved in.

The doctors who operated on the woman – critically injured when a teenage stunt went awry, sending a 20-pound turkey through her windshield - could offer no more than a hopeful prognosis.

"It's too early to tell," said Dr. Prajoy Kadkade, a head and neck surgeon at the hospital.

But there was some good news yesterday: Ruvolo's condition was upgraded from critical to serious. She was being weaned from her tracheotomy tube and the swelling in her face was receding.

If all goes well, doctors predict Ruvolo, 44, of Lake Ronkonkoma, will look the same as she did before the accident. Her injuries appear to be mostly limited to her face. She suffered no cuts, so when the swelling recedes she'll have no scars.

"At some point down the road she may need a nose job," said Dr. Maisie Shindo, associate professor of surgery at Stony Brook University Hospital and one of the surgeons who operated on Ruvolo.

Six teenagers have been charged in a Nov. 13 shopping spree with a stolen credit card that ended with one of them, Ryan Cushing of Huntington, allegedly tossing the turkey out the window of a moving car. Ruvolo was driving toward them when the bird sailed through her windshield and smashed her face.

Since then, the hospital has received cards and phone calls, and even a suggestion for treatment, from well-wishers cheering for a full recovery for Ruvolo, a supervisor at a Garden City collection agency, hospital spokesman Dan Rosett said. Among them was a Seattle woman who said her daughter was in a similar accident and wanted to offer support.

"I felt so pulled by this woman," said a sobbing Robin Abel, of Renton, Wash., whose 24-year-old daughter Maria Federici was severely injured by a 50-pound board that flew through her windshield in February." Knowing what it's like to be on the other end and seeing my daughter suffer made me want to reach out."

Family members referred requests for comment to attorney Paul Feuer, who said friends and neighbors have sent flowers and called to comfort Ruvolo's siblings. He said relatives plan to spend a quiet Thanksgiving at her hospital bedside.

Doctors said Ruvolo's injuries were severe but not necessarily unusual for a blunt force trauma.

She suffered minor bleeding in the frontal lobe of her brain. Her jawbone had been fractured and so had her cheeks. One fissure in her left cheek extended into her nose and her left eye socket.

"Because there were so many fractures, the middle of her face was sinking and had to be pulled back up," Kadkade said.

They worried her smashed palate and nose were constricting her airway, so they inserted tubes into her throat to help her breathe.

Before they could operate, doctors needed to make sure Ruvolo, still unconscious, was stable. A neurosurgeon examined her and determined the bleeding behind her forehead was contained and would stop on its own. An eye doctor decided her eyes didn't seem damaged. Another specialist checked for neck injuries and found none.

One thing puzzled doctors: For some reason, large pockets of air were trapped inside the tissue in Ruvolo's face, neck and chest. The air showed up as dark blobs on a CAT scan. Normally this would indicate a larynx injury or collapsed lung. They checked her throat and found nothing. Her lungs seemed fine.

Doctors finally decided that injuries in Ruvolo's sinus cavity had allowed the oxygen pumped into her by paramedics to seep into her tissue.

Their biggest indicator of problems, though, was Ruvolo's teeth. They were intact but weren't fitting together properly, a sign that her whole face was misaligned.

So at 1 p.m. Thursday, five days after she was injured, Kadkade and Shindo went to work on what would be an eight-hour operation. First they performed a tracheotomy to improve Ruvolo's breathing. They made an incision under her top upper lip and lifted her skin around her cheeks to expose the bones.

The fractures, far behind her cheeks, left some give in the bones that allowed doctors to actually lift Ruvolo's face. Kadkade reached inside her mouth and for leverage grabbed her upper teeth to yank her face forward.

This also helped align her teeth, which guided doctors to the rest of her facial structure. They wired her jaw shut to keep her teeth in position. "Once [Kadkade] got the jaw stable he was able to realign it like a jigsaw puzzle," Shindo said.

Then they placed four small titanium plates, about 4 millimeters wide, across fracture lines in her cheeks and eye socket, using tiny screws to attach them to bones. Into her damaged left eye socket they inserted a bit of synthetic film that works like scaffolding to keep her eyeball from falling in.

Ruvolo's left cheekbone had been broken into several small pieces but they were large enough for the doctors to identify. So, surgeons placed the bones back into proper position.

"The plates will lock the bones in the right place, and they should heal," Kadkade said. "As long as we were able to get the bones in the right orientation, once the swelling goes down, she will look pretty much the same."

Ruvolo's long-term outlook is unclear. Hospital officials say it's too early to tell whether she will have effects from the bleeding in her brain. They will continue to monitor her eyesight. She risks sinus infection and drainage problems, and for a while she might have a stiff jaw.

"I'm just glad she's turning the corner," Shindo said.

Copyright, 2004, Newsday. Reprinted with permission
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