Midface reconstruction.

In the midface, two polyhedron-shaped maxillary units are separated by the central midportion, which includes the nasal area. The midface includes such facial features as the nose, cheek, and upper lip, and posteriorly it extends to the anterior skull base. In the superoinferior direction, the midface includes the soft and bony tissue from the orbital cavity to the oral cavity. Laterally, the midface extends to the temporal bone. Although most superficial skin defects of the midface can be covered by various standard reconstructive modalities, because of the need to evaluate the nature of the tissues involved and because of structural and also functional considerations, the management of large, full-thickness defects is a challenge for reconstructive surgeons. Advances in microsurgical techniques have permitted reliable wound closure and a substantial decrease in patient morbidity with low complication rates while allowing a variety of reconstructive flap options in a single stage. To create a reconstructive algorithm, several classification systems have been proposed, mostly relating to the extension, location, and tissue involvement of the defect. Defects can be classified as simple soft tissue defects and complex defects. The complex three-dimensional defect is classified under four types: types I to IV. Although maxillary prostheses are nonliving tissues and may cause discomfort for the patient, in special situations they can be reconstructive options requiring special experience. Essentially, the method of reconstruction should be selected on an individual basis, bearing in mind the medical situation; the age and prognosis of the patient; the size, extension, and composition of the defect; and the availability of local or distant tissues.