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To review all pertinent topics related to midface and maxillary reconstruction including current classification schemes and reconstructive techniques.The maxilla represents the functional and aesthetic cornerstone of the midface region. Defects in this area represent a unique challenge to the reconstructive surgeon as the complex anatomy of this area can be challenging to repair and reconstruct. The current indications as well as advantages and disadvantages of different reconstructive approaches are reviewed here in order to provide reconstructive surgeons with optimal information for surgical and clinical decision making in this challenging patient population. Recent developments in midface reconstruction options including near total facial transplant as well as tissue engineering techniques are also reviewed.Multiple reconstructive pathways can be followed in restoring maxillary and midface defects. The surgeon and rest of the reconstructive team must make individualized decisions based on the nature of the defect as well as the specific needs and concerns of the patient when selecting the optimal reconstructive approach for each patient.