The aims of this paper are to show the management of osteoradionecrosis and tumor recurrence on the reconstruction fl ap after maxillectomy and to describe the ideal fl aps for reconstruction. A 50-year-old male with post-operative recurrent squamous cell carcinoma of the right maxillary sinus and post-radiotherapy osteoradionecrosis is presented. Salvage radical excision followed by reconstruction with combined free anterolateral thigh (ALT) fl ap and pedicled pectoralis major myocutaneous (PMMC) fl ap is introduced. Uneventful recovery with excellent structural support and aesthetic result are achieved. There is no tumor recurrence during a 7-year follow-up. Although less encouraging results are found in recurrent advanced sinonasal malignancies, with a frustratingly low 5-year survival rate, radical surgical excision still has a role in curing the disease. The consequent facial disfi gurement, the most important concern of patients, can be managed by reconstruction with combined free ALT fl ap and pedicled PMMC fl ap with excellent outcome.