Microvascular reconstruction of oncologic defects of the midface

Reconstruction of a midfacial defect can represent a formidable challenge for the reconstructive surgeon. Attesting to both the variety and the complexity of midfacial defects, numerous different classification schemes have been proposed, and are reviewed in this article. The approach to reconstruction can be simplified, however, by classifying maxillectomy defects into four types. Understanding the complex three-dimensional anatomy of the maxilla and its relationship to contiguous structures is the first step in approaching reconstruction of the midface. Achieving basic functional and aesthetic goals of maxillary reconstruction can be achieved using free flap reconstruction with good reliability and predictability in the majority of patients. A specific approach to each defect type is outlined.