Procedures performed:

1. Orbital floor implant removal
2. Upper eyelid myocutaneous skin flap for fistula reconstruction
3. Full thickness skin graft from neck to upper eyelid donor defect

A patient with a history of hemimaxillectomy, including cheek skin and orbital floor resection followed by pedicled latissimus flap and Medpore titanium implant placement, presents with a nasocutaneous fistula seven years after the initial orbital implant placement. We describe a unique upper eyelid myocutaneous skin flap that was used to reconstruct the troublesome fistula with a two-layer reconstruction. This type of fistula is commonly seen in patients who have undergone Weber Ferguson or lateral rhinotomy incisions with a history of postoperative radiation.