Background and objectives: Since the origin of facial reconstruction, rehabilitation of the midface appears as one of the most challenging for Maxillofacial surgeons. In fact, it combines both aesthetic and functional constraints and involve in most of cases pluritissular reconstructions. Nowadays, fibula free flap appears as the gold standard in these cases, because of it multiple advantages and most particularly, the possibility to support implant rehabilitations. However, this flap also presents constraints and morbidities of its donor site which led us to develop alternatives. The innovation with the reconstruction technique we present has been to deeply incorporate megaplate’s design into midface reconstruction. Thus, megaplates have been design to completely reproduce the shape of lacking bone and have been hollow out to receive bone for implant rehabilitation. But, plates’ designs also integrate implant anchorages in order to directly connect prosthesis to plates if necessary. The objective of our presentation will be to report our experience with this new custom made material.

Methods: We will report our experience and precocious results in our two first cases. They were presenting ballistic injuries with large maxillary defects. We studied morbidity of their donor sites but also aesthetic and functional reattempts on their midface, including speech, breathing and feeding.

Results: Our results on both donors and reconstructed sites are good. Clinical and radiological analysis of the patients showed a good reshaping of their midface. Great improvements of patients’ breathing, feeding and speech have been noticed.

Conclusion: That technique has not yet eliminated the necessity of free flap but reduce patients’ morbidity. Further cases and improvements of the technique, as well as its combination with other tissular engineering techniques will be necessary but should led to a credible alternative to classical reconstruction of the midface.