Key points in orbital reconstruction

Orbital fractures represent the most challenging fractures of the facial skeleton to treat. Decision making in the management of patients with orbital fractures is often demanding, requiring experience and profound knowledge of the anatomical and functional aspects of this anatomical region. The complex anatomy and functionality of the orbital area, along with the limited visibility of the surgical field and the extreme surgical precision required, make the reconstruction of this region extremely demanding, thus necessitating an experienced surgeon with high surgical technical skills. The restoration of orbital walls, proper orbital volume, globe position, and periorbital soft tissues represents the goal of orbital reconstruction, aiming for the recovery of normal orbital function while avoiding post-traumatic enophthalmos. To date, various aspects of the management and treatment of these post-traumatic orbital defects remain debated. Controversies exist regarding indications, timing of surgery, surgical approach, and reconstruction materials. Furthermore, recent advances in computer-assisted surgery, including intraoperative navigation and customized plates, have marked a turning point in the management of these fractures, and certainly represent an excellent resource and aid. However, different surgical strategies and the use of new technologies do not override or replace the fundamental principles of orbital reconstruction. This work revisits the key concepts that have defined the evolution of orbital reconstructive surgery, as well as the role of new technologies, emphasizing how the anatomical key points of orbital reconstruction remain the most important factors for correct post-traumatic reconstruction.