Introduction: The reconstruction of the anterioposterior inclination of the medial aspect of the
orbital floor, despite a wide 360-degree exposure including coronal and conjunctival
incisions, is a challenging task in severe injuries of the orbit with massive comminution
and complete displacement of the medial orbital wall and orbital floor.
Material and Methods: Out of a total of 20 patients with orbital fractures, 5 underwent a surgical intervention
of repositioning the medial aspect of the orbital floor and especially the transition
area between the orbital floor and medial orbital wall, using navigation-aided procedures.
Results: Postoperative CTs indicated an average difference of the globe position of −4.9%
between the operated side and the unaffected side, depending on the position of the
medial aspect of the orbital floor.
Conclusions: Navigation-aided procedures proved to be an essential precondition for achieving
precise and predictable results in orbital reconstruction. In such cases, unlike those
with an intact medial orbital wall remnant as a surgical target, bone grafts for reconstruction
of the orbital floor cannot be implanted as onlay grafts. Navigation-aided procedures
also facilitate decompression of the optic nerve. A treatment algorithm for optic
nerve injuries with the help of visual evoked potentials is outlined.
