Systematic review of autologous midface reconstruction methods: palatal and limited midfacial defects

The repair of isolated palatal and limited midfacial defects remains a demanding surgical task requiring consideration of anatomical restoration, functional recovery, and patient quality of life. This systematic review aimed to identify current autologous reconstructive strategies with a focus on functional outcomes. A PRISMA-guided search identified 75 articles encompassing more than 800 patients. For small-to-moderate hard and soft palate defects, local and pedicled flaps were the mainstay, with survival rates consistently above 90% and rapid restoration of speech and swallowing. Larger or more complex defects required free flaps, particularly radial forearm and anterolateral thigh flaps, sometimes combined with secondary procedures to improve velopharyngeal competence or facilitate prosthetic planning. In limited midfacial defects, anterior alveolar ridge defects frequently required composite free flaps to restore form and function and enable dental rehabilitation, whereas lateral defects were reliably managed with pedicled options such as temporalis muscle or buccal fat pad flaps. Despite favourable outcomes, marked heterogeneity in reporting, particularly of patient-reported outcome measures, precluded meaningful comparison of reconstructive options. Future studies should standardize functional assessments and integrate surgical and prosthetic planning to support evidence-based, function-driven reconstruction.