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It behooves us to understand the power of gravity or its diminished or negative effect as we, Homo sapiens, evolve from going around from four limbs to bipedalism or working mostly erect or sitting on our buttocks. Evolution doesn’t favor a particular desire or anticipate the future; its particular end is to get that individual to live long and propagate more efficiently. Evolution cannot give you all the favorable advantages; only that selfish genes will make us the top predators. Unfortunately the locations of the paranasal sinus ostia are not top in the list of favorable advantages. Hemorrhoids, chronic back pain, varicous veins, etc are other morbid consequences of bipedalism.

The use of local regional flaps is often the most practical and easy means of reconstruction in the management of head and neck tumors. The temporalis muscle coronoid swing has been used to reconstruct the orbital floor and is described in literature as early as 1983. Difficulty is encountered when the medial wall and orbital floor are completely removed and a temporalis muscle-coronoid swing is rendered insufficient for orbital reconstruction. Objective: To describe a combination of forehead island flap and temporalis muscle-coronoid swing in orbital reconstruction. Design: Surgical Innovation/ Case Report. Subject: 12-year-old female with recurrent maxillary chondroblastic osteosarcoma one year after chemotherapy. Methods: The course of tumor excision and defect reconstruction is described. Results: There was no diplopia or other morbidity. There was minimal added operative time for reconstruction with acceptable results. Conclusion: Local flaps can be combined in order to repair the orbital floor. Acceptable function with minimal cosmetic deformity can be achieved with less extensive surgery. Keywords: Forehead flap, temporalis muscle, coronoid, orbit, reconstructive surgical procedures, maxillectomy