Primary reconstruction of orbital fractures can be difficult due to the complexity of the anatomical region involved, the limited operative view, the extreme precision required for surgery, and possible surgical complications.

Manson et al. described two of the fundamental principles of surgical correction of orbital defects: a full dissection of the bony orbital soft tissues, especially in the posterior orbit; and bony orbital volume restoration by insertion of a plate to correct the vertical and anteroposterior position of the ocular globe (Manson et al., 1987; Grant et al., 1997). These principles highlight one of the most important elements of accurate orbital reconstruction — the positioning of the plate. Current efforts are directed towards the development of optimal orbital titanium meshes, preoperative planning software, and intraoperative navigation technologies (Scolozzi et al., 2010; Fawzy et al., 2022; Osaki et al., 2020).

Although the use of customized orbital implants is becoming increasingly popular, preformed meshes still appear to be the most common plates used for orbital fracture treatment (Huempfner-Hierl et al., 2015; Nikunen et al., 2021). In addition, the most recent preformed meshes have been shown to have the right shape to guarantee accurate reconstruction of the orbital wall anatomy — for the orbital floor, with or without medial wall fractures (Nikunen et al., 2021; Purnell et al., 2018).

Both plates still require meticulous placement, allowing only one position, because a different positioning might lead to errors during reconstruction. Intraoperative navigation has allowed increasing degrees of accuracy in the treatment of orbital fractures. Since its appearance, numerous articles have endorsed its effectiveness for orbital reconstruction. Many studies have aimed to compare orbital reconstruction precision using a customized orbital implant or a preformed titanium mesh. In most of these, orbital reconstruction was significantly more precise when customized implants were used. However, the role of navigation in the use of individualized implants makes it difficult to truly attribute the improved precision only to the customized implant (Zimmerer et al., 2016; Rana et al., 2015a).

To date, there has been no study comparing the precision of orbital reconstruction using customized or preformed orbital meshes in a truly homogeneous group of patients.

The aim of our study was to compare the precision of orbital reconstruction and the surgical benefits of 3D preformed orbital mesh and customized orbital implants, respectively, using preoperative virtual surgical planning (VSP) and intraoperative image-guided navigation in the early treatment of unilateral inferomedial orbital fracture.

Furthermore, the authors aimed to demonstrate that the quality of orbital reconstruction results is proportional to the accuracy of the mesh position. Thus, the use of intraoperative navigation would allow accurate reconstruction of the orbit with the preformed titanium mesh as well as with the customized implant. A prospective intraoperative application of these two techniques was used over a period of 6 years, in a single center and in a single-operator case series, and the results were analyzed retrospectively.