Typically, the treatment of oral cancer in very elderly patients should be by brief surgical therapy because chemotherapy and irradiation tend to be exhausting for them. The authors report here on a case they experienced in which the lost part of the maxilla after excision of maxillary gingival cancer in a very elderly patient was reconstructed using a nasolabial flap combined with pedicled buccal fat pad, and a positive outcome was achieved. The patient was an 87-year-old female. The chief complaint upon referral was gingival lesion on the maxillary left side, which was diagnosed by biopsy as squamous cell cancer. A TNM classification of T2N0M0 was decided after further evaluations. Under general anesthesia, partial maxillectomy and closure of oro-antral and oro-nasal communications using a nasolabial flap combined with pedicled buccal fat pad were performed. The combination flap became stable early in the postoperative period. Oral intake was allowed on day 7 and the patient was discharged on day thirteen after surgery. We conclude that this reconstructive surgery may be a useful method after excision of maxillary gingival cancer in very elderly patients.