History, Innovation, Pearls, and Pitfalls in Complex Midface Reconstruction

While midface reconstruction is challenging, it also is very rewarding, as a successful reconstruction can help restore both form and function. Over the years, there have been great strides in our ability to reconstruct complex defects of the midface, with refinements made in microvascular surgery and free tissue transfer providing arguably the greatest impact in midface reconstruction. While patients with small, simple de-fects of the maxilla can still be offered an obturator for reconstruction, when evaluating larger, more complex defects of the midface, reconstruction with a free flap should be highly considered. The advent of virtual surgical planning has made the reconstruction of even the most complex maxilla and midface achievable, with growing evidence to support improved anatomical, cosmetic and functional outcomes. While the cost -benefit of this tool is still to be determined most head and neck reconstructive sur-geons and centers have integrated it as standard of care for complex defects. We advocate for the use of virtual surgical planning in revision cases, complex cancer cases including osteoradionecrosis or osteomyelitis, or patients with complex trauma and blast injuries to the midface. While pedicle length and the need for vein graft are always potential issues encountered with midface reconstruction, with a proper reconstructive plan these cases can safely and efficiently be performed. Overall, mid -face reconstruction is an intricate but gratifying procedure that can restore a patient's quality of life.