Introduction Reconstructing the maxilla after maxillectomy is essential for restoring speech and swallow. The zygomatic implant perforated (ZIP) flap, a fasciocutaneous free flap combined with perforated zygomatic implants, provides oronasal sealing and rapid dental rehabilitation. This technique avoids the morbidity of traditional osteocutaneous reconstructions and avoids functional and stability issues seen with obturating larger defects. Case Summary A 49-year-old male with a 30mm palatal lesion, diagnosed as low-grade adenocarcinoma of minor salivary gland origin (cT2N0M0), underwent a right infrastructure maxillectomy, neck dissection, and ZIP flap reconstruction. The defect was consistent with a Brown class IIb maxillectomy.1 A zygomatic implant was perforated through a radial artery forearm free flap (RAFF). The patient had a 7-day hospital stay, began soft diet on day 5, and had a temporary implant-supported prosthesis placed by day 20. At 6 months, functional outcomes were excellent, with an MD Andersen Dysphagia Inventory (MDADI) score of 99/100 and a Speech Handicap Inventory (SHI) score of 2/120. No complications were encountered. Histopathology confirmed carcinoma ex-pleomorphic adenoma completely resected and adjuvant therapy was not required. Literature Review A systematic review of 5 articles (89 ZIP flap cases) showed a 93% flap survival rate, median dental rehabilitation time of 29 days, and favourable outcomes at 3 months (median MDADI: 93, SHI: 45). Conclusion The ZIP flap offers an excellent reconstructive option for smaller maxillary defects with excellent flap survival, dental rehabilitation time and speech and swallow outcome measures while avoiding the complexity and morbidity associated with osteocutaneous reconstruction sometimes required for larger defects. 1.Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck. 2000 Jan;22(1):17-26