Orbital floor fractures are among the most frequent facial injuries, and precise reconstruction is essential to prevent both functional and aesthetic complications. Virtual Surgical Planning (VSP) combined with pre-shaped titanium mesh has transformed orbital reconstruction. This study aimed to evaluate whether VSP-assisted surgery with pre-modeled mesh provides greater accuracy and reduced operative times compared with conventional intraoperative mesh shaping. A case-control study was performed on 52 patients treated at the "Federico II" University Hospital of Naples for large pure orbital floor fractures. Twenty-four patients (Group A) underwent VSP-assisted reconstruction using a preformed titanium mesh, while twenty-eight patients (Group B) received conventional intraoperative mesh modeling. Operative time, postoperative diplopia, infraorbital sensory disturbance, mesh malposition, screw loosening, and infection were compared in the two groups. Clinical and radiological follow-up was conducted at 12 months. Median operative time was significantly shorter in Group A compared with Group B (55 min [IQR 50-65] vs. 110 min [IQR 98-125]; p < 0.001). Persistent diplopia occurred in 4 % of patients in Group A and 28.6 % in Group B (p = 0.028). Implant malposition was observed exclusively in Group B (25 % vs. 0 %; p = 0.011). Other postoperative complications, including infraorbital nerve alterations, eyelid malposition, wound dehiscence, screw loss, and infection, were more frequent in Group B but did not reach statistical significance. No cases of postoperative ocular motility limitation or iatrogenic fracture were observed in either group. VSP with pre-modeled titanium mesh significantly reduces operative time and postoperative complications, enhancing reconstructive precision and outcomes in orbital floor fracture management. This virtual protocol is useful for reducing the costs and waiting times of custom-made implants, manufactured by external companies.

Orbital fractures are common after craniofacial trauma. A rare but severe complication is retrobulbar hematoma (RBH), potentially causing increased intraorbital pressure, optic nerve compression, and irreversible vision loss. Prompt diagnosis and emergency decompression, typically via lateral canthotomy, are critical. Despite its low incidence, the relationship between fracture morphology and RBH remains insufficiently understood. This study investigates the association between orbital floor fracture characteristics and RBH occurrence. In this retrospective single-center study, we analyzed all patients who presented to our department between 2015 and 2025 with CT-confirmed RBH and elevated intraocular pressure (IOP) following orbital trauma. CT-based fracture morphology was assessed and classified by size, fragmentation, and wall involvement. Findings were correlated with clinical parameters, including IOP, initial and postoperative visual acuity, and the need for surgical intervention. Statistical analyses evaluated associations between fracture features and clinical severity. We analyzed 27 patients with RBH following orbital trauma, mainly involving the orbital floor, typically caused by falls or assault. Ipsilateral visual acuity was initially reduced (0.15 (0.00-0.80)), improving after decompression; IOP also decreased significantly. Functional outcomes were associated with fracture pattern and, to a lesser extent, anticoagulation. Several Association of the Study of Internal Fixation (AO) fracture types correlated with clinical outcomes. Receiver operating characteristic analysis showed that orbital floor displacement predicted preoperative visual acuity (AUC=0.75, cut-off 4.7mm), while medial wall displacement poorly predicted IOP or vision initially. Postoperatively, medial wall displacement showed excellent discrimination for IOP normalization (AUC=0.944); however, neither wall predicted visual outcome reliably. The extent and displacement of orbital fractures, along with intraocular pressure, strongly correlated with functional outcomes. Our findings highlight the prognostic value of CT-based fracture assessment in addition to urgent clinical evaluation and suggest that trauma mechanism and patient profile further influence risk and recovery.

ABSTRACT Purpose To determine whether prophylactic antibiotic administration following the development of an orbital floor fracture or after orbital floor fracture repair is associated with a reduced risk of orbital or periorbital cellulitis. Methods A multicenter retrospective cohort study was designed using data obtained from the TriNetX United States Collaborative Network. Patients with orbital floor fractures were categorized by antibiotic exposure within 14 days of diagnosis. Similarly, patients who underwent orbital floor fracture repair were queried to determine whether or not they received antibiotics either at the time of surgery or in the immediate postoperative period. The primary outcome was orbital or periorbital cellulitis within 180 days, assessed after 1:1 propensity-score matching for demographic and clinical variables. Statistical analyses were then performed to determine differences in the two groups. Results Among 3,169 matched pairs, antibiotic use was associated with higher cellulitis incidence after incident orbital floor fracture (1.93% vs 0.57%, respectively; RR = 3.40, p < 0.0001). In 1,116 matched pairs who underwent orbital floor fracture repair, patients who received antibiotics were more likely to develop orbital cellulitis than those that did not (2.69% vs. 1.08%, respectively; RR = 2.50, 95% CI [1.29–4.86], p = 0.005). Conclusion Prophylactic antibiotics did not reduce infection risk after incident orbital floor fracture or after floor fracture repair and were associated with higher cellulitis rates. While clinical decision making may depend on a variety of factors, routine use of antibiotics in these settings may not be appropriate.

A modified orbital index for CT-based risk stratification in pediatric and adolescent orbital floor fractures.

Orbital floor fractures impair ocular function and often need surgical repair. Super FIXSORB, a bioresorbable u-HA/PLLA composite, offers osteoconductivity and strength. However, few studies have quantitatively assessed functional recovery after reconstruction with this material. This study aimed to evaluate the clinical course and key pitfalls following orbital floor reconstruction using Super FIXSORB, focusing on motility recovery, bone remodeling, and diplopia. We retrospectively reviewed 20 patients with isolated orbital floor fractures who underwent reconstruction with Super FIXSORB at one center. Extraocular motility was assessed using HESS chart analysis; globe position was evaluated via computed tomography (CT). In 15 cases, the location of bone fragments relative to the plate was measured using coronal CT. Subjective diplopia was graded with a standardized system. The mean 30-degree HESS score improved from 0.765±0.18 to 0.949±0.09. Sixteen patients achieved HESS >0.85 within 2 months postoperatively, and none worsened. In 15 cases with measurable gaps between bone and implant, the median fragment-to-plate distance (FPD) decreased from 5.40mm (IQR 3.28-7.58) to 1.21mm (0.76-1.89) (P=0.000061), indicating progressive remodeling toward the plate. Globe position on CT stayed within ±2mm in all patients. No infections or implant-related issues were noted. Super FIXSORB reconstruction led to early, lasting improvements in motility and structural stability. CT analysis showed gradual bone migration toward the plate, consistent with osteoconduction. Still, clinicians should note that favorable HESS scores may not fully predict diplopia resolution, especially with muscle entrapment.

Orbital floor fractures are among the most common maxillofacial injuries and represent the predominant type of isolated orbital fractures. Residual diplopia is a common complication in these patients, and its management is quite challenging. The present study aimed to investigate predisposing factors for late residual diplopia following surgical repair of orbital floor fractures. : Patients presenting with maxillofacial trauma between 2019 and 2024 were retrospectively analyzed. Individuals diagnosed with orbital floor fractures were included. Data regarding concomitant wall involvement, preoperative diplopia, mechanism of trauma, time interval between trauma and surgery, defect size, and postoperative enophthalmos were obtained from patient records. Patients with a follow-up period of less than 3 months were excluded from the study. These variables were statistically compared to assess their relationship with persistent postoperative diplopia. A total of 109 patients with orbital floor fractures were evaluated. Post-traumatic diplopia was observed in 15.6% of cases. The presence of residual enophthalmos was significantly associated with residual diplopia (p< 0.001): 56.3% of patients with enophthalmos exhibited diplopia compared to 8.6% without. "Floor+rim" fractures demonstrated a higher incidence of diplopia (20.9%) than other wall combinations (p= 0.054). The interval between trauma and surgery was not correlated with diplopia (p= 0.425), whereas increasing defect size was significantly associated (p= 0.039). Although diplopia was more frequent in assault (19.4%) and collision (28.6%) cases, the difference was not statistically significant (p= 0.578). : Persistent postoperative diplopia remains a challenging complication after orbital fracture repair. The strong association between residual enophthalmos and diplopia underscores the need for meticulous intraoperative reconstruction and close postoperative follow-up to optimize functional and aesthetic outcomes.

Orbital floor fractures in pediatric patients present unique challenges due to the complex anatomy, ongoing facial growth, and potential for functional and aesthetic sequelae. We report the case of a 13-year-old patient who sustained an orbital floor fracture secondary to blunt trauma. Clinical examination revealed enophthalmos, diplopia on upward gaze, and infraorbital hypoesthesia. Radiological assessment, including computed tomography, confirmed a defect of the right orbital floor. Surgical reconstruction was performed using an autologous iliac crest bone graft, secured with microplates and screws to restore orbital volume and support the globe. Postoperative outcomes demonstrated satisfactory aesthetic and functional results, with resolution of diplopia and recovery of orbital contour. No donor site complications were observed. This case highlights the efficacy of iliac crest bone grafting for orbital floor reconstruction in pediatric trauma, providing a durable and biocompatible solution while minimizing long-term complications. Early intervention and meticulous surgical planning are essential for optimal outcomes in the growing facial skeleton.

Orbital emphysema refers to the presence of air within the orbital tissues and most commonly develops following trauma involving the paranasal sinuses or orbital walls. Although typically benign and self-limiting, it may rarely cause vision-threatening complications due to orbital compartment syndrome. The authors report a case of traumatic orbital emphysema presenting with clinical features suggestive of an orbital floor fracture. A 35-year-old man presented with left periorbital swelling and limitation of upgaze after blunt trauma. Orbital computed tomography demonstrated intraorbital air compressing the globe from the superior orbit without evidence of orbital floor fracture. The patient was managed conservatively with systemic antibiotics and intravenous methylprednisolone, resulting in complete recovery of eyelid edema and ocular motility at 1 month. This case highlights that orbital emphysema can mimic orbital floor fracture and underscores the importance of careful clinical-radiologic correlation to avoid misdiagnosis and unnecessary surgical intervention.

Background/Objectives: Reconstruction of orbital floor fractures remains surgically challenging due to limited intraoperative visibility and complex anatomy. Inaccurate implant placement often leads to persistent complications and the need for a revision surgery. This study evaluated the clinical accuracy and re-operation rates of a preoperative 3D-printed model-assisted technique compared to the conventional intraoperative free-hand mesh bending method. Methods: A comparative ambispective study was conducted on 74 patients with isolated orbital floor fractures. The control group (n = 34, retrospective) underwent reconstruction using intraoperatively formed titanium meshes. In the study group (n = 40, prospective), patient-specific 3D-printed models, created by mirroring the healthy contralateral orbit, were used for preoperative mesh adaptation. Primary outcomes included the rate of revision surgery due to implant malposition, changes in orbital volume, and postoperative diplopia. Results: The 3D model group demonstrated a significantly lower rate of revision surgery compared to the control group. In the retrospective group, 5 patients (15%) required reoperation due to implant malposition, whereas no patients (0%) in the prospective 3D group required secondary intervention (p = 0.017). While both techniques effectively restored orbital volume, the 3D group showed greater volumetric precision with less variance. The mean volume difference in the affected orbit was 3078 ± 2204 mm3 in the control group, compared to 2390 ± 1893 mm3 in the study 3D group. At the 6-month follow-up, persistent diplopia was observed in 12% of the control group compared to only 3% in the study group. Conclusions: The use of in-house 3D-printed models for preoperative mesh forming significantly enhances surgical precision and eliminates the need for revision surgery due to implant malposition. This workflow offers a cost-effective, predictable, and accessible alternative to expensive patient-specific implants (PSIs) or intraoperative navigation systems, improving patient safety and long-term clinical outcomes.

Orbital floor fractures may cause long-term functional and esthetic impairments. Diplopia due to impaired function of the inferior rectus muscle is frequently an indication for surgical repair, but some cases, such as those where the diagnosis has been delayed or a previous attempt at repair has been made, may not always be amenable to surgical correction. It is advantageous for the surgeon to know whether the proper function of the inferior rectus muscle can be restored for the purposes of surgical planning and prognostication. The authors hypothesized that real-time MRI could be used to characterize the appearance of the inferior rectus muscle in a way that would facilitate future analysis of inferior rectus function in patients with diplopia due to orbital floor fractures. Real-time MRI was performed on 10 volunteer participants with normal ophthalmic function and orbital anatomy to assess inferior rectus appearance during vertical duction testing. ImageJ software was used to measure and record characteristics of the inferior rectus muscle, viewed in a quasi-sagittal plane. The ratios evaluated included inferior rectus muscle length in upgaze versus downgaze (UDR, mean 1.58) as well as inferior rectus muscle length versus distance from inferior rectus origin to inferior rectus inflection point in upgaze (LIR, mean 1.30) and downgaze (mean 1.20). These values were found to be conserved between orbits and individuals. This data offers quantitative insight regarding inferior rectus muscle appearance across the full arc of vertical gaze in healthy individuals. We plan to use this normative baseline dataset as a comparison for future phases of this project, using real-time MRI to evaluate traumatized orbits with diplopia and derangement of the inferior rectus muscle.

Social determinants of health are acknowledged as significant factors affecting trauma occurrence, severity, and outcomes. The area deprivation index (ADI) is a validated tool that combines social determinants into a single measure of "neighborhood disadvantage." We aimed to investigate whether ADI was linked to injury severity and other clinical benchmarks in orbital floor fracture patients. Patients presenting to a single Level 1 Emergency Department with acute orbital floor fracture were reviewed. Data on additional trauma, length of stay (LOS), and follow-up attendance were collected. Patients were classified into a stable, urgent, or critical condition based on initial clinical presentation. Neighborhood socioeconomic disadvantage was evaluated using national percentile and state decile ADI. Analyses were conducted using chi-squared tests, Mann-Whitney U, Spearman rank correlations, and Kruskal-Wallis tests. A total of 1255 patients with acute orbital floor fractures were analyzed. ADI was significantly higher in patients with additional facial trauma (national ADI: 55 vs. 51, p = 0.0240; state ADI: 7 vs. 6, p = 0.0119). However, ADI was not significantly associated with the incidence of bodily polytrauma, initial clinical acuity, or LOS. Follow-up attendance rates did not differ by ADI. Social disadvantage was significantly associated with differences in injury characteristics and indirectly with care utilization among orbital floor fracture patients. This may reflect different mechanisms of injury in high ADI areas and indicate that ADI may be useful as a contextual marker of injury severity. Future studies should investigate these mechanisms and other risk factors unique to high ADI areas.

The orbital floor is the most fragile region of the facial skeleton and is highly prone to fractures, making precise anatomical restoration essential to prevent complications. Among surgical approaches, the subciliary and transconjunctival techniques are most commonly used. Closure is typically performed in 2 layers: periosteum and skin. A prospective, experimental, longitudinal comparative study was conducted at a tertiary care hospital in western Mexico between July and October 2024. A total of 100 patients with orbital floor fractures were randomly assigned into 2 groups. Group 1 underwent skin-only closure, whereas group 2 received combined periosteal and skin closure. Outcomes evaluated included postoperative complications (eyelid retraction and ectropion) and the need for surgical reintervention on days 8, 15, and 30, along with demographic variables and comorbidities. The sample included 88 men (88%) and 12 women (12%), with a mean age of 34.8 ± 12.3 years. A significantly higher incidence of eyelid retraction was observed in the combined closure group during the first week (16% versus 2%; P = 0.014) and second week (20% versus 6%; P = 0.037). No significant differences were found between groups regarding ectropion or reintervention rates at any time point. Smoking, present in 29% of patients, was not associated with increased complications (P = 0.826). In conclusion, periosteal plus skin closure was associated with a higher incidence of eyelid retraction, without reducing ectropion or reintervention rates compared with skin-only closure.

Background: Facial trauma remains a major public health issue, with causes that vary by region. National statistics often overlook local trends, which highlights the need for region-specific studies to create targeted prevention and treatment plans. Methods: This retrospective review included 801 patients with facial fractures at a Level 2 urban trauma center, which serves the Tulsa metropolitan area with a population exceeding 1,000,000 residents. Data from patient records and the trauma registry between 2021 and 2024 were analyzed for demographics, injury mechanisms, fracture details, Injury Severity Score (ISS), comorbidities, treatments, and geographic origin (Tulsa versus other areas). χ 2 tests examined categorical variables, while nonparametric tests evaluated continuous variables. Results: Most patients were male (73.8%) with an average age of 47.9 years. The main causes of injury were falls (23.4% overall; 51.0% in females versus 21.8% in males, P &lt;0.001) and assaults (22.5% overall; 28.9% in males versus 13.8% in females, P &lt;0.001). Firearm injuries were uncommon but more frequent among men (4.4% versus 0.5%, P &lt;0.05). Falls made up 90.3% of injuries in patients over 85 years old ( P &lt;0.001). Major trauma (ISS &gt;15) was seen in 25.6% of cases. Orbital floor fractures (16.1%) were more common than Le Fort fractures (8.4%). Comorbidities included substance use disorder (17.1%) and mental or psychiatric illnesses (12.2%). Patients from Tulsa had lower median ISS (9 versus 11, P =0.005) but higher rates of assault (31.9% versus 20.3%) and firearm injuries (5.0% versus 2.3%; P &lt;0.05). Conclusion: In this urban Midwestern population, falls were more common in females and older adults, while intentional violence was higher among males and Tulsa residents. These findings underscore the need for tailored interventions: fall prevention for older adults and women, violence screening for men, and integrated approaches to substance use and mental health treatment.

SummaryObjective:This study aimed to investigate and analyse the complications and outcomes of orbital fracture repair in Oman.Methods:This multicentre retrospective study included all patients with orbital floor and/or medial wall fractures who underwent orbital reconstruction at four tertiary hospitals in Oman between January 2014 and December 2021. The data collected included demographics, fracture aetiology, surgical approach, reconstruction material, complications and repair outcomes.Results:A total of 41 patients were included in this study. Motor vehicle collisions (MVCs) were the most common cause of orbital fractures, accounting for (53.7%) of the patients. Isolated orbital fractures were encountered in 25 patients, 12 patients had orbital fractures associated with the zygomaticomaxillary complex and 4 had fractures associated with naso-orbital ethmoidal fractures. The transconjunctival approach was the most common surgical method (36.6%), followed by the infraorbital approach (24.4%). Titanium mesh was the primary implant material used in (63.4%) of the cases. The most common complications at 2-weeks to 3-months postoperatively were enophthalmos (17.1%) and residual diplopia (13%). Beyond 3 months postoperatively, complications occurred in 10 patients, resulting in an overall complication rate of (24.4%). Analysis of 24 postoperative computed tomography scans revealed that the ideal implant positioning in the anterior, middle and posterior zones was achieved in (87.5%), (45.8%) and (12.5%) of the cases, respectively.Conclusion:The study findings showed that MVCs were the primary cause of orbital fractures in Oman. The complication rate of orbital reconstruction was low and comparable to that reported in the published literature.

ABSTRACT Purpose Cyanoacrylate tissue adhesives have been used successfully in different branches of the medical field. The purpose of this study was to assess the safety and efficacy of porous polyethylene implant fixation with N-butyl cyanoacrylate tissue adhesive. Methods A retrospective chart review was conducted for all patients with orbital floor fracture who underwent surgical repair with a high-density porous polyethylene (Medpor) implant fixated with N-butyl-2-cyanoacrylate tissue adhesive glue from January 2000–December 2018. Results Thirty-seven patients were included. The median interval between trauma and surgery was 7 months (interquartile range, 0.7–24 months), and the median duration of the last follow-up also 7 months (interquartile range, 1.2–31 months). The indication for surgery was diplopia in 19 (51.3%) patients, enophthalmos in 22 (59.5%), limited ocular motility in 12 (29.7%), and combined canalicular laceration with orbital floor fracture in 1 (2.7%). Thirty-five (94.6%) patients showed either partial or complete improvement in their symptoms after surgery, either subjectively or objectively after the first operation, regardless of the presence of subsequent operations. No patient exhibited implant displacement or implant-related infections. Conclusion Overall, these findings suggest that N-butyl-2-cyanoacrylate fixation of high-density porous polyethylene implants for orbital floor fractures is safe and effective.

ABSTRACT Purpose We aimed to evaluate the risk factors of ocular complications associated with orbital fractures in a large cohort of patients. Methods In this retrospective study, we analyzed the medical records of 1416 consecutive orbital fracture patients treated at Kyoto Prefectural University of Medicine, Kyoto, Japan between March 2009 and April 2025. Fracture characteristics, causes of injury, and the frequency of ocular complications were assessed via clinical records and associated computed tomography scan images. The factors associated with ocular complications were evaluated with multivariate logistic regression analysis. Results Ocular complications occurred in 9.5% of the cases, with traumatic mydriasis, hyphema, and commotio retinae being the most common. Multivariate logistic regression identified sports-related injury (OR,2.19; 95% CI, 1.73–2.77, p < .01), male sex (OR,1.51; 95% CI, 1.12–2.03, p < .01), non-trapdoor fracture (OR,1.34; 95% CI, 1.01–1.80, p < .05), combined medial wall and orbital floor fractures (OR,1.32; 95% CI, 1.05–1.67, p = .02) and zygomatic or maxilla bone fracture (OR,1.34; 95% CI, 1.00–1.79, p < .05) as independent predictors of ocular complications. Sports-related injury, particularly those associated with golf and baseball, showed the highest rate of ocular complications, with golf-related orbital fractures resulting in a 100% complication rate and baseball-related orbital fractures resulting in a 38.1% complication rate. Conclusion Sports-related injuries, male sex, non-trapdoor fractures, combined medial wall and orbital floor fractures and zygomatic or maxilla bone fracture are risk factors for ocular complications. Golf and baseball related orbital fractures are associated with a particularly high incidence of ocular complications, and urgent ophthalmologic examination is warranted in these cases.

Orbital reconstruction following trauma remains challenging due to complex three-dimensional (3D) anatomy and limited surgical access. While pre-fabricated titanium mesh is standard, it requires extensive intraoperative manipulation and produces imaging artifacts. The 3D-printed polyetheretherketone (PEEK) patient-specific implants (PSIs) offer potential advantages; however, limited data exists for the acceptance of PEEK PSIs by surgeons compared to other established techniques. Fourteen surgeons performed simulated orbital reconstructions on nine cadaveric heads comparing titanium mesh and the 3D-printed PEEK PSIs. Titanium mesh was used for Class II orbital floor fractures, while the 3D-printed PEEK PSIs (native and radiopaque formulations) were used for Class IV defects. Surgeons were blinded to the PEEK formulation type. Outcomes included operative efficiency, handling characteristics, fit quality, and mechanical stability using validated 5-point Likert scales and objective timing. The 3D-printed PEEK PSIs demonstrated faster procedure times (9.5 ± 5.3 vs. 11.2 ± 5.1 min) and superior fit quality (2.00 ± 1.04 vs. 2.18 ± 0.60) and mechanical stability (1.67 ± 0.49 vs. 1.91 ± 0.54), with 100% rated stable versus 91% for the titanium mesh. Surgeons could not distinguish between the native and radiopaque PEEK formulations. Most surgeons (64.3%) preferred situation-dependent material selection. The 3D-printed PEEK PSIs demonstrated advantages in handling, fit quality, and mechanical stability for complex defects, while the titanium mesh showed a lower learning curve for simple reconstructions. Radiopaque enhancement expands PEEK's clinical utility without compromising handling.

Introduction: Orbital floor fractures are common facial injuries that often result in functional and aesthetic impairment. Open Reduction and Internal Fixation (ORIF) using various materials, like Poly Lactic-Co-glycolic Acid (PLGA) mesh and titanium mesh, have been employed to repair these fractures. Need of the study: Recent advancements in hybrid bone mesh, including bioactive materials or elements to promote fracture healing, show significant promise. One such innovation involves using biodegradable PLGA material to create a bone screw mesh, which has demonstrated benefits for fracture healing and has gained interest recently. These developments aim to enhance treatment plans for patients by offering superior aesthetic and functional properties. However, evidence comparing their functional and aesthetic outcomes is limited. Aim: The present randomised controlled trial aims to compare and evaluate the functional and aesthetic outcomes of ORIF using PLGA mesh and titanium mesh in patients with orbital floor fractures. Materials and Methods: A randomised single-blinded controlled trial will be conducted at Siddharth Gupta Memorial Cancer Hospital (AVBRH), Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India, from September 2024 to December 2025. A total of 12 patients presenting with orbital floor fractures will be included and two parallel groups, A and B, will be allocated by randomisation and they undergo ORIF using either or titanium mesh (Group A- Control group) or PLGA mesh (Group B-Experimental group). Functional outcomes, including diplopia, enophthalmos, ocular motility, and infraorbital nerve function, will be assessed using standardised clinical measures. Aesthetic outcomes will be evaluated based on facial symmetry, globe position, and patient satisfaction using validated scoring systems. Followup assessments will be conducted at regular intervals of 10-15 days. An unpaired t-test will be applied for intergroup comparison, and a p-value of less than 0.05 will be considered statistically significant.

Orbital floor fractures are a common consequence of maxillofacial trauma and can result in significant functional and esthetic morbidity, including diplopia, enophthalmos, and impaired ocular motility if not accurately reconstructed. Conventional freehand orbital floor reconstruction relies heavily on intraoperative judgment and visual estimation, which may compromise precision, particularly in complex defects involving posterior orbital anatomy. The objective of this review is to evaluate the clinical effectiveness, accuracy, and feasibility of three-dimensional (3D)-printed patient-specific surgical guides in the management of orbital floor fractures. A comprehensive literature review was conducted using major electronic databases to identify prospective and comparative clinical studies assessing guide-assisted orbital reconstruction, with an emphasis on surgical accuracy, functional outcomes, complication rates, and workflow efficiency. The reviewed evidence demonstrates that 3D-printed surgical guides enable more precise implant positioning and improved restoration of orbital volume by translating virtual preoperative planning into reproducible intraoperative execution. Radiological assessments consistently show reduced discrepancies between reconstructed and contralateral orbits, while clinical outcomes indicate lower rates of postoperative diplopia, enophthalmos, and need for revision surgery compared with conventional techniques. 3D-printed surgical guides represent a promising adjunct in orbital floor fracture management, offering enhanced precision, predictability, and improved functional and esthetic outcomes, although further standardized and cost-effectiveness studies are warranted.

Changes in Orbital Volume following Reconstruction with Alloplastic Materials in Patients with Orbital Trauma.