Circumspectus Medicinae: Text and ContextSkeletofacial Reconstruction for Cleft-Related Deformities Four Decades of Evolving Cleft CareDenadai, Rafael MDa,b; Chou, Pang-Yun MDa,b; Pai, Betty C. J. DDSc; Chen, Chit MDd; Cheng-Hui Lin, Clement MDa,b; Huang, Chiung-Shing DDS, PhDc; Chen, Yu-Ray MDa,b; Lo, Lun-Jou MDa,bAuthor Information From the aDepartment of Plastic and Reconstructive Surgery bCraniofacial Research Center cDepartment of Craniofacial Orthodontics dDepartment of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Received September 21, 2019, and accepted for publication, after revision September 30, 2019. Conflicts of interest and sources of funding: none declared Statement of institutional review board approval: The study was reviewed and approved by the Institutional Review Board, Chang Gung Medical Foundation (201900523B0A3). Reprints: Lun-Jou Lo, MD, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Shin St, Kwei Shan, Taoyuan 333, Taiwan. E-mail: firstname.lastname@example.org. Annals of Plastic Surgery: July 2020 - Volume 85 - Issue 1 - p 3-11 doi: 10.1097/SAP.0000000000002187 Buy Metrics Abstract Skeletofacial reconstruction in skeletally mature patients with cleft lip/palate can be challenging because of multifaceted condition-specific anatomical features in addition to several repercussions from surgical intervention during the growing period. This surgical report presents the history and evolving philosophy of cleft-skeletofacial reconstruction at the Chang Gung Craniofacial Center, a referral center for cleft care in Taiwan. The maximization of satisfactory function and the appearance outcome-burden ratio have been the fundamental aims for this team to develop and upgrade cleft-skeletofacial reconstruction over the past 4 decades, with more than 10,000 mature patients treated. The study highlights key lessons learned in outcome-based and patient-oriented changes over time until the current approach, which focuses on patient-centered care with a comprehensive, multidisciplinary, and team-based model. Substantial advances in surgical, orthodontic, anesthetic, and computer imaging aspects have contributed to improving and optimizing the correction of a broad spectrum of facial and occlusal deformities while ensuring safety, predictability, efficiency, and stability in outcomes. Understanding the development and refinement of cleft-skeletofacial reconstruction over the time and transferring these time-tested and scientifically validated protocols and principles to clinical practice may serve as a reliable foundation to continue the advancement and enhancement of the delivery of surgical cleft care worldwide. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.