Navigation-Aided Reconstruction of Medial Orbital Wall and Floor Contour in Craniomaxillofacial Reconstruction

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.