There has been a gradual shift of the utilization of pectoralis major myocutaneous (PMMC) pedicled flaps with the current advancements in the successful development of vascularized free flaps. Currently, PMMC flaps are considered a salvage mechanism after failure of a free vascularized flap or used as the reconstructive option for patients who are considered poor candidates for free flaps. This review discusses the PMMC flap for reconstruction of the oral and maxillofacial region, from preoperative considerations and anatomy to surgical technique and possible complications. Advantages and disadvantages for such flaps are also discussed.