The purpose of this study was to review eight patients undergoing midfacial skeletal reconstruction following extensive resection of tumors based on the principles of restoration of three maxillary buttresses, the nasomaxillary, zygomaticomaxillary, and pterygomaxillary. The zygomaticomaxillary skeletal defects were reconstructed with a three-dimensionally contoured piece of titanium mesh, vascularized costal cartilage, or vascularized bone flap of scapula and rib. Restoration of the zygomaticomaxillary buttress prevented the inferior deviation of the orbit and provided good zygomatic contour. Restoration of the nasomaxillary buttress prevented the superior and posterior deviation of the alar base of the nose, and restoration of the pterygomaxillary buttress prevented the superior and posterior deviation of the upper lip. Combination of the V-shaped scapular bone and the rib flap based on the thoracodorsal vascular system, which provides simultaneous reconstruction of all three buttresses, is a very versatile technique for reconstruction of extended midfacial skeletal defects. In this series, both of the patients reconstructed with titanium mesh presented with late persistent cutaneous fistulas. We now recommend a vascularized autologous soft and bony tissue reconstruction for midfacial composite defects.