title: Long-term results after 40 years experience with treatment of rare facial clefts: Part 2--Symmetrical median clefts.
abstract: BACKGROUND
  Median facial clefts are reconstructive challenges, requiring multiple operations throughout life. Long-term results are often still far from ideal and could be improved. Due to surgical intervention and diminished intrinsic growth potential, surgical results may change from initially good into a progressively disappointing outcome. If, however, the ideal timing and type of surgery are known, in combination with the intrinsic growth potential, the results can be ameliorated. A guideline for surgical treatment is given.
  
  
  METHODS
  Twenty patients with a pure symmetrical median cleft were evaluated on intermediate and long-term surgical results. The final result was scored based on severity of the initial and the remaining facial deformities, and the need for revisional surgery.
  
  
  RESULTS
  The long-term surgical outcome was initially good for each of the affected facial parts and the face in general, but worsened over time, especially in the zone of the nose. An adequate and stable result of hypertelorism correction was observed for both the orbital box osteotomy and medial faciotomy, even when performed at a young age.
  
  
  CONCLUSIONS
  The intrinsic growth restriction is mainly localised in the central midface. This leads to a complex and often unpredictable growth of the maturing face. It makes it difficult to achieve perfect reconstructions. Caution with surgical interventions of the nose at a young age is required. Once the face has matured, a midface advancement and secondary nose correction should be considered for satisfactory projection. Early referral to a specialised centre is essential.
authors: Department of Plastic and Reconstructive Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands. m.vandenelzen@erasmusmc.nl
authors: Marijke E P
authors: ME
authors: van den Elzen
authors: Sarah L
authors: SL
authors: Versnel
authors: Eppo B
authors: EB
authors: Wolvius
authors: Marie-Lise C
authors: ML
authors: van Veelen
authors: J Michiel
authors: JM
authors: Vaandrager
authors: Jacques C
authors: JC
authors: van der Meulen
authors: Irene M J
authors: IM
authors: Mathijssen