Osseous reconstruction of the midface and orbits

The midface or orbitonasomaxillary complex is an intricate three-dimensional entity with important functional and aesthetic purpose. Bony reconstruction of defects caused by resection of malignancy, congenital abnormalities, or trauma requires close attention to both function and the complex anatomy. Replacement of bone should be done in the functional anatomic position. Free bone grafts require a well-vascularized bed and may require adjuvant soft-tissue reconstruction prior to their placement. Vascularized bone through the temporoparietal fascial flap and free tissue transfer provides an excellent method of replacement of the bony components of these complex defects. Currently available free tissue transfers can be modified to best meet the needs of the defect.