The Cleft-Craniofacial Center was established in Chang Gung Memorial Hospital in 1981 by Dr. Samuel Noordhoff. The cleft care has evolved over the years. The multi-disciplinary team has been set up, the surgical technique continues to improve, and the treatment protocol has evolved. We have learned from our patients and the treatment results, and transformed ourselves so that the current methods and protocol are the best ever. The aims of our craniofacial center are to provide comprehensive team care to patients with cleft lip and palate as well as other congenital and acquired craniofacial deformities, to advance the field of craniofacial research, and to innovate surgical techniques in the treatment of these patients.
　　The treatment team includes surgeons, orthodontists, speech pathologists, social workers, nursing specialists, and coordinators. Other specialties are by referral system but also in close collaboration relationship, including pedodontists, ENT doctors, psychologists, neurosurgeons, ophthalmologists, and anesthesiologists, etc. A lot of prenatal diagnoses of fetus with cleft have been made. Adequate information is given to the mother for their mental preparation. In the first visit, feeding education is provided, and the treatment protocol is explained. As indicated, preoperative nasoalveolar molding is administered to the baby. The first operation is performed at 3 months of age for the lip repair and primary nasal reconstruction. Rotation-advancement method with modification is performed. The second operation is to repair the cleft palate at 9 months of age. This is a one-stage repair closing the hard and soft palate using a two-flap method in the hard palate and double-opposing z-plasty in the soft palate. The levator veli palatine was reconstructed, and the soft palate is lengthened. The patient is followed up in the clinic. The first speech evaluation and education is started at 2 years 6 months of age. There is no need to perform secondary rhinoplasty in the preschool age. The speech function is always adequate and only 5 percent of patients required a secondary surgery for velopharyngeal insufficiency. At 9 years of age, alveolar bone grafting is performed for the alveolar cleft and closure of nasoalveolar fistula. Success rate of the bone grafting was one of the best in the world literature, being 94.6% according to the Bergland classification. Orthodontic treatment for the dental deformity is performed at 12 years of age or deferred if there is a sign of maxillary retrusion and orthognathic surgery is indication after the growth spurt. Then the patients are regularly followed up until 18 years of age, when a final evaluation is performed. With this treatment protocol, the majority of patients with cleft lip and palate have good results and satisfied with the outcome. From their childhood to adulthood, the psychosocial support is provided by the Noordhoff Craniofacial Foundation as well as the Chang Gung Craniofacial Team.
　　Starting from 1998, we have established and sent volunteer cleft care team to the neighboring developing countries like Vietnam, Cambodia, Indonesia, Philippines, China, Mongolia, Myanmar, etc. Our short-term goal is to give free cleft treatment medical consultation and to demonstrate surgery to them that we expect it would stimulate local surgeons or institution to cooperate with us. From 1998 to 2017, we have completed more than 75 overseas volunteer cleft surgery missions and treated more than 1,600 patients with cleft or craniofacial anomalies. Our mid-term goal is to train surgeons, orthodontists, speech pathologists/therapists, and nursing specialists either in the local hospital setting or bringing them back to the Craniofacial Center of Chang Gung Memorial Hospital in Taiwan for further training. Up to now, we have trained more than 150 medical personnel to be the “seed” doctors. The seed doctors are expected to go back to their home countries to provide cleft care, to teach local medical staff, and to establish local treatment center. Our long-term goal is assist them to set up the local craniofacial center or medical team and combine the local resources to set up a foundation to make them self-sufficient and independent.