Improvements in the art of midface reconstruction

The unique three-dimensional structure and function of the midface make defects of this region among the most challenging problems faced by reconstructive surgeons. Not only does the cavity need to be obliterated and midfacial contours recreated but the restoration of swallowing function, phonation, and mastication is also imperative for an ideal result. Traditionally these defects have been obturated by a maxillofacial prosthesis, but advances in tissue transfers, particularly microvascular free flaps, have greatly expanded reconstructive options. A wide variety of both soft tissue and bone-containing free flaps have been described in the literature. Each flap offers unique properties that may be applicable depending on the defect. Several authors have made efforts to classify these midfacial defects and provide appropriate algorithms for optimal reconstruction. Advances in the field of osseointegration have also enhanced the ability to achieve optimal function and form.