Introduction: Reconstruction of midface defects is a challenge for the oral and maxillofacial surgeon. Ablative surgery, due to tumour and traumatic cases, causes an alteration of the stomatognathic system.

Materials and methods: We have reviewed 28 maxillectomies performed between 2008 and 2013 at Gregorio Marañón Hospital in Madrid. We classified the defects according to Browns classification of vertical and horizontal maxillectomy and midface defects (2010).

Results: For class Ia–b defects, we have selected the buccal fat and the buccinator flap. If the maxillectomy is a Ic type, we use either the nasolabial flap or a bone distractor. Temporalis flap is useful for class IIa–IIb defects, being the fibula flap the treatment for IIc maxillectomies. The iliac crest or the temporoparietalis fascia with parietal bone and temporalis muscle are the ideal flaps for defects type 3b. When isolated orbital enucleation is performed we use the temporalis flap with a cervicopectoral flap. For class IV defects including orbital exanteration we use the rectus abdominis free flap.

Conclusions: In our experience, primary reconstruction (aesthethic and functional) is the goal in every patient. There is no evidence-based gold standard technique for maxillectomies.