RESUMEN
OBJECTIVES: The aim of this study was to analyse changes in facial soft tissue thickness (FSTT) after corrective surgeries for dental malocclusion. The correlation between body mass index (BMI) and sex of patients and their FSTT before undergoing surgery was analysed. MATERIALS AND METHODS: Cone beam computed tomography of seventeen patients that underwent Le Fort I osteotomy in combination with bilateral sagittal split osteotomy were collected. Hard and soft tissue landmarks were selected basing on the interventions. FSTT were computed, and measurements from pre- to post-operative were compared. The relationship between FSTT, sex, and BMI was investigated. RESULTS: Considering the comparison between pre- and post-operative measurements, any significant difference emerged (p > .05). The Pearson's correlation coefficient computed between BMI and the FSTT (pre-operative) showed a correlation in normal-weight patients; the region-specific analysis highlighted a stronger correlation for specific landmarks. Higher median values emerged for women than for men; the subset-based analysis showed that women presented higher values in the malar region, while men presented higher values in the nasal region. CONCLUSIONS: The considered surgeries did not affect the FSTT of the patients; differences related to BMI and sex were found. A collection of FSTT mean values was provided for twenty landmarks of pre- and post-operative of female and male subjects. CLINICAL RELEVANCE: This exploratory analysis gave insights on the behaviour of STT after maxillofacial surgeries that can be applied in the development of predictive methodologies for soft tissue displacements and to study modifications in the facial aspect of the patients.
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Puntos Anatómicos de Referencia , Maloclusión , Humanos , Masculino , Femenino , Cara/diagnóstico por imagen , Cara/anatomía & histología , Tomografía Computarizada de Haz Cónico , Osteotomía Le Fort/métodos , Cefalometría/métodosRESUMEN
OBJECTIVE: Tumor resection and reconstruction as a one-step procedure requires accurate definition of the intended safety margins, precise location of osteotomy lines and reliable individual rehabilitation.In recent years, the role of image-guided surgery in the maxillofacial region has increased significantly. As this technology allows the surgeon to track the actual position of each instrument during the operation in real-time, it makes it possible to perform extensive bone structure resections and reconstructions in anatomically distorted or complex areas, such as the head and neck region, without unnecessarily damaging vital structures.The authors described a case of a 26-year-old woman presented to our Clinic with an extensive maxillary squamous cell carcinoma involving the infratemporal fossa. The patient underwent single-step navigation-guided en bloc resection of the tumor and defect reconstruction.The aim of this study is describe and discuss the unusual surgical planning and the challenging operative technique adding a new case to the currently limited scientific literature on the computer-assisted head and neck oncologic surgery.
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Neoplasias Maxilares , Procedimientos de Cirugía Plástica , Cirugía Asistida por Computador , Adulto , Femenino , Peroné/cirugía , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Neoplasias Maxilares/diagnóstico por imagen , Neoplasias Maxilares/cirugíaRESUMEN
BACKGROUND: The possibility of placing dental fixtures in the reconstructed regions allows us to overcome the problems related to dental rehabilitation with removable prosthesis. The aim of this study was to assess the clinic-radiological outcome in a series of patients who underwent fibula flap jaws reconstruction and rehabilitation with implant-supported prosthesis with a minimum follow-up of 24 months. MATERIAL AND METHODS: The study included 10 patients who underwent reconstruction with fibula free flap between 2010 and 2018. Albrektsson criteria were used to define the implant survival. The follow-up evaluation was performed according to a standardized protocol including clinical examination, radiological evaluation (panoramic radiograph) and patient interview. RESULTS: A total of 45 implants were positioned.The time between mandibular reconstruction and implant placement ranged from 13 months to 39 months.The prosthesis used was fixed in 6 cases and supported overdenture in 4 cases.No implant failure was observed.Regarding implant survival no infections were observed in these series. Nine patients out of 10 had no pain and signs of mobility. Seven patients out of 10 had absence of peri-implant radiolucency at the panoramic radiograph.One patient presented with an overgrowth of granulomatous soft tissue around the implant abutments that caused pain. CONCLUSIONS: Implant placed in vascularized bone grafts are a safe and reliable opportunity to rehabilitate patients following mandibular resection. The results of this series demonstrate a high survival rate for implants placed in reconstructed mandibles with an improvement of the quality of life.
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Implantes Dentales , Colgajos Tisulares Libres , Trasplante Óseo , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Peroné/cirugía , Humanos , Mandíbula/cirugía , Calidad de Vida , Resultado del TratamientoRESUMEN
Orbital location of teratoma is extremely rare. The differential diagnosis can be difficult and they may be mistaken for other tumors as they may have both cystic and solid areas. The authors report a case of a 7-day-old neonate with a massive congenital orbital teratoma in which it was decided to apply a surgical technique that involves the aspiration of the cystic fluid, the subsequent infusion of fibrin glue, and the radical excision. The definitive histological examination reported a diagnosis of trifillic cystic teratoma. At fourth year of follow up the patient is free from disease.
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Quiste Dermoide , Neoplasias Orbitales , Teratoma , Diagnóstico Diferencial , Humanos , Recién Nacido , Órbita/diagnóstico por imagen , Órbita/cirugía , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/cirugía , Teratoma/diagnóstico , Teratoma/cirugíaRESUMEN
PURPOSE: The purpose of this retrospective study was to analyze the epidemiology, patterns, and management of maxillofacial due to road traffic accidents over a 17-year period. METHODS: Between January 2001 and December 2017, 2924 patients with maxillofacial fractures were admitted to the Division of Maxillofacial Surgery, Turin, Italy.The following data were analyzed: age, gender, data of the trauma, alcohol and drug abuse, mechanism of injury, fracture site, facial injury severity scale, associated injuries, type of treatment, and length of hospital stay. RESULTS: Of the 605 patients included in the study, 419 were male and 186 were female (ratio, 2.2:1). The most common mechanism of injury was car accidents (62.6%).More than half of the patients had fractures of the middle third of the maxillofacial skeleton.Associated injuries were detected in 172 (45.5%) patients. In total 5.3% of patients did not undergo surgery. The average hospital stay was 7.3 days. CONCLUSIONS: This study shows an important reduction in maxillofacial fractures following road traffic accidents since the turn of the new millennium. At least in north-western Italy, road safety policies implemented in the last 30 years seem to have affected the behavior of motorists and motorcyclists.
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Accidentes de Tránsito/estadística & datos numéricos , Traumatismos Maxilofaciales , Humanos , Italia/epidemiología , Tiempo de Internación/estadística & datos numéricos , Traumatismos Maxilofaciales/epidemiología , Traumatismos Maxilofaciales/etiología , Traumatismos Maxilofaciales/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND: The purpose of this study was to prospectively test the accuracy of computer-aided orthognathic surgery comparing the virtual surgical planning with the three-dimensional (3D) outcome. METHODS: Patients that underwent computer-assisted orthognathic surgery were retrospectively evaluated. The postoperative results were compared with the surgical plan, superimposing the postoperative computed tomography (CT) scan onto the virtual plan. Surface-based superimpositioning of the postoperative CT scan onto the 3D preoperative plan was carried out to visualize the discrepancy between preoperative virtual plan and postoperative 3D CT result. RESULTS: A total of 17 consecutive patients that underwent two-jaw computer-assisted orthognathic surgery were enrolled in the study.The average linear differences for selected points were <1âmm in 12 patients out of 17. In 5 patients out of 17, the average differences for selected points were <2âmm. CONCLUSIONS: An overall high degree of accuracy between the virtual plan and the postoperative result was found.
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Diseño Asistido por Computadora , Mandíbula , Maxilar , Planificación de Atención al Paciente , Adulto , Precisión de la Medición Dimensional , Femenino , Humanos , Imagenología Tridimensional/métodos , Italia , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Procedimientos Quirúrgicos Ortognáticos/normas , Evaluación de Procesos y Resultados en Atención de Salud , Cuidados Preoperatorios , Estudios Retrospectivos , Cirugía Asistida por Computador/métodosRESUMEN
The purpose of this paper is to report a rare patient of oral myofibroma in a 12-year old patient and to describe its clinical, histopathologic, and immunohistochemical features to establish the correct diagnosis and surgical management.Pathological and immunohistochemical examination is a mandatory method for establishing a definitive diagnosis of this lesion avoiding unnecessary treatment. Surgical excision and careful postoperative observation should be a treatment option.
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Neoplasias Gingivales/cirugía , Miofibroma/cirugía , Procedimientos Quirúrgicos Orales/métodos , Biopsia , Niño , Femenino , Neoplasias Gingivales/diagnóstico , Humanos , Miofibroma/diagnósticoRESUMEN
AIM: The purpose of this study was to analyze the accuracy of computer-assisted free fibula flap for reconstruction of large mandibular defects for benign tumors. MATERIALS AND METHODS: Between December 2012 and January 2014, a total of 4 free osteocutaneous computer-assisted fibula flaps have been used in an equal number of patients for reconstruction of the mandible at the Division of Maxillofacial Surgery, Città della Scienza e della Salute Hospital, University of Turin. Inclusion criteria were large mandibular defects due to benign tumors. The computer-assisted fibula flap was chosen when 2 or more osteotomies were requested. Intraoperative complication, mean ischemia time, operative time, and morphologic outcomes were analyzed in all cases. After surgery, a postoperative computed tomography compared the virtual plan with the surgical results. RESULTS: All 3 flaps were harvested and transplanted successfully. For the free flaps examined in this work, no intraoperative complications were noted. Postoperative computed tomography showed high correspondence in terms of bone contour according to the virtual plan. The immediate and long-term morphologic results were satisfactory. CONCLUSIONS: Microsurgical mandible reconstruction using a computer-assisted fibula flap technique is the best available method to manage complex defects.
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Trasplante Óseo/métodos , Diseño Asistido por Computadora , Peroné/trasplante , Colgajos Tisulares Libres , Mandíbula/cirugía , Reconstrucción Mandibular/métodos , Diseño de Prótesis , Humanos , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/cirugía , Tomografía Computarizada EspiralRESUMEN
We describe here a peculiar case of a 30-year-old woman presenting with an orbital trapdoor fracture. Preoperative and postoperative magnetic resonance images are provided to explain the mechanism of the injury.
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Fracturas Orbitales/patología , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Músculos Oculomotores/patologíaRESUMEN
Pleomorphic adenoma (PA) is the most common benign mixed salivary gland tumor. We describe here a peculiar case of a 72-year-old woman with a PA of the palate resected with palatal approach combined with Le Fort I osteotomy, adding to the currently limited scientific literature on intraoral approach for removal of extensive tumors of the midface. The Le Fort I osteotomy approach allows direct visualization of the tumor and ensures a wide excision, increasing safety and minimizing the possibility of recurrence.
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Adenoma Pleomórfico/cirugía , Huesos Faciales/cirugía , Osteotomía Le Fort/métodos , Hueso Paladar/cirugía , Neoplasias de las Glándulas Salivales/cirugía , Anciano , Femenino , HumanosRESUMEN
AIM: The objective of this study was to evaluate the incidence of plate-related complications after vascularized bony reconstruction of the mandible, comparing the plate type used. PATIENTS AND METHODS: Between 2004 and December 2012, a total of 41 free osteocutaneous fibula flaps have been used in an equal number of patients for reconstruction of the mandible, at the Division of Maxillofacial surgery, San Giovanni Battista Hospital, University of Turin. Malignant pathology was the most common indication for segmental mandibulectomy.Patient outcomes were retrospectively evaluated with special attention to plate complications such as plate fracture, exposure, infection, and bony nonunion.The types of reconstruction plates used were mandible plates 2.0, locking plates 2.0, miniplates (<2.0), and locking 2.4 plates. RESULTS: Mandible plates 2.0 were used in 14 patients, locking plates 2.0 in 12 patients, and locking 2.4 plates in 4 patients. The most commonly used plates were miniplates, which were used in 86 patients.A total of 5 plate complications occurred after 41 procedures in an equal number of patients.Two complications occurred in patients receiving 2.0 mandible plates (2/14). One complication occurred in patients receiving 2.0 locking plates (1/12). Two complications occurred in patients receiving miniplates (2/86). CONCLUSIONS: In our experience, miniplates are not associated to a high rate of complications comparing to other plates. The advantage of these plates and the low rate of complications make them our first choice for mandibular reconstructions.
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Placas Óseas/efectos adversos , Trasplante Óseo/métodos , Peroné/trasplante , Colgajos Tisulares Libres , Reconstrucción Mandibular/métodos , Complicaciones Posoperatorias , Adulto , Anciano , Femenino , Humanos , Masculino , Traumatismos Mandibulares/cirugía , Neoplasias Mandibulares/cirugía , Osteotomía Mandibular/métodos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE: The aim of this study was to present retrospective analysis of our experience regarding complications associated with the donor site after oral mucosa harvest for urethral reconstruction. MATERIALS AND METHODS: Between May 2010 and January 2013, a total of 18 patients with recurrent urethral strictures received a buccal mucosal graft for urethral reconstruction at the San Giovanni Battista Hospital, University of Turin, Turin. All operations were performed in a 2-team approach. All patients were retrospectively evaluated by clinical examination and using a questionnaire. RESULTS: Urethroplasty with oral mucosa graft was performed successfully in a 1-step procedure in 17 of 18 patients. No intraoperative complications were observed.The most common complication occurring at the buccal donor site was scarring and contracture (n = 3). CONCLUSIONS: Oral mucosa graft for urethroplasty is a simple and safe method in the interdisciplinary treatment of urethral strictures. Donor-site morbidity measured by clinical assessment and questionnaire is tolerable.
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Mucosa Bucal/cirugía , Procedimientos de Cirugía Plástica/métodos , Recolección de Tejidos y Órganos/métodos , Sitio Donante de Trasplante/cirugía , Estrechez Uretral/cirugía , Adulto , Cicatriz/etiología , Contractura/etiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/trasplante , Grupo de Atención al Paciente , Complicaciones Posoperatorias , Recurrencia , Estudios Retrospectivos , Cirugía Bucal , Encuestas y Cuestionarios , Uretra/cirugía , UrologíaRESUMEN
This report describes a peculiar case of needle breakage during inferior alveolar nerve block to perform third molar extraction that was removed with the aid of a BrainLAB VectorVision neuronavigation system. This report adds to the currently limited scientific literature on the image-guided removal of foreign bodies from the oral cavity.
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Falla de Equipo , Cuerpos Extraños/cirugía , Nervio Mandibular , Agujas/efectos adversos , Bloqueo Nervioso/instrumentación , Cirugía Asistida por Computador/métodos , Cuerpos Extraños/diagnóstico por imagen , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Inyecciones/instrumentación , Masculino , Mandíbula/diagnóstico por imagen , Tercer Molar/cirugía , Músculos Pterigoideos/diagnóstico por imagen , Radiografía Panorámica , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Extracción Dental , Adulto JovenRESUMEN
PURPOSE: The aim of this study was to evaluate surgical outcomes using patient-specific prostheses produced by computer-aided design and manufacturing for primary reconstruction in patients with benign cranio-orbital tumors. Polyetheretherketone was used to manufacture the implants. MATERIALS AND METHODS: The present study included 3 patients who underwent fronto-orbito-pterional craniotomy using individual custom-made surgical guides. Patient-specific polyetheretherketone prostheses were used for reconstruction during the same surgery. All patients underwent esthetic examination (facial and orbital symmetry, globe projection and position), ophthalmologic examination (diplopia with the Hess-Lancaster test, visual field and acuity), and radiologic evaluations (computed tomography and magnetic resonance imaging) during the preoperative and follow-up periods. Operating time and short- and long-term complications were recorded. RESULTS: The immediate and long-term morphologic results were satisfactory; in particular, ocular globe position and projection were correct. After 25 to 31 months, none of the patients developed implant-related complications, such as infection, extrusion, or malposition. Two-year postoperative computed tomograms and magnetic resonance images showed no recurrences. CONCLUSION: Single-step resection and reconstruction with computer-aided designed and manufactured implants is a challenging new technique that decreases operative time and morbidity. The implants adequately restore an anatomically complex area with satisfactory cosmetic results.
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Diseño Asistido por Computadora , Craneotomía/métodos , Neoplasias Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Diseño de Prótesis , Implantación de Prótesis/métodos , Neoplasias Craneales/cirugía , Anciano , Benzofenonas , Sustitutos de Huesos/química , Diplopía/etiología , Ojo/patología , Femenino , Estudios de Seguimiento , Hemangioma/cirugía , Humanos , Cetonas/química , Masculino , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Persona de Mediana Edad , Tempo Operativo , Órbita/patología , Planificación de Atención al Paciente , Polietilenglicoles/química , Polímeros , Complicaciones Posoperatorias , Implantación de Prótesis/instrumentación , Procedimientos de Cirugía Plástica/instrumentación , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Interfaz Usuario-Computador , Agudeza Visual/fisiología , Campos Visuales/fisiologíaRESUMEN
Adequate tumor resection and preservation of facial nerve function are the primary goals of the parotidectomy. However, this technique may lead to undesirable effects, including a concave facial effect, Frey syndrome, and prominent scar.The aim of this study is evaluate the outcomes of facial symmetry and symptomatic Frey syndrome in patients having dermofat graft during superficial parotidectomy.The incidence of symptomatic Frey syndrome was lower in patients who received dermofat graft and so was the facial asymmetry rate, but these differences were not statistically significant.
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Tejido Adiposo/trasplante , Cicatriz/prevención & control , Asimetría Facial/prevención & control , Enfermedades de las Parótidas/cirugía , Glándula Parótida/cirugía , Neoplasias de la Parótida/cirugía , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias/prevención & control , Sudoración Gustativa/prevención & control , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We describe the surgical management of an uncommon case of ossifying fibroma affecting the mandibular condyle. A condylectomy was performed with an immediate temporomandibular joint reconstruction by a total temporomandibular joint prosthesis.
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Fibroma Osificante/cirugía , Prótesis Articulares , Cóndilo Mandibular/cirugía , Neoplasias Mandibulares/cirugía , Procedimientos de Cirugía Plástica/métodos , Implantación de Prótesis/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Biopsia , Femenino , Fibroma Osificante/diagnóstico por imagen , Fibroma Osificante/patología , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/patología , Persona de Mediana Edad , Osteotomía , Radiografía Panorámica , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/patología , Tomografía Computarizada por Rayos XRESUMEN
We describe the surgical management of an uncommon case of synchronous presentation of central giant cell granuloma and ossifying fibroma in the mandible. A mandibular resection was performed and a fibula-free flap was harvested to reconstruct the defect.
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Enfermedades Mandibulares/cirugía , Neoplasias Mandibulares/cirugía , Fibroma Osificante/complicaciones , Fibroma Osificante/cirugía , Peroné/cirugía , Estudios de Seguimiento , Colgajos Tisulares Libres/trasplante , Granuloma de Células Gigantes/complicaciones , Granuloma de Células Gigantes/cirugía , Humanos , Masculino , Enfermedades Mandibulares/complicaciones , Neoplasias Mandibulares/complicaciones , Reconstrucción Mandibular/métodos , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Sitio Donante de Trasplante/cirugíaRESUMEN
BACKGROUND: The aim of this paper was to report our experience and to review the literature of arthrocentesis focusing on protocols and results. METHODS: Arthrocentesis with supplemental hyaluronic acid was performed in patients with TMDs between January 2017 and December 2020 at the Division of Maxillofacial Surgery. The maximum interincisal opening (MIO) and pain score were recorded preoperatively (T0), 2 months postoperatively (T1), and 6 months postoperatively (T2). A literature search was performed to analyze the same parameters in patients with TMDs. Patient demographic, characteristics and treatment protocols used were also recorded. RESULTS: This retrospective analysis enrolled 45 patients. Twenty-two patients (20 females, 2 males) with mean age of 37.13 years with internal derangement were included in study group A. Study group B included 23 patients with degenerative joint disease (19 females and 4 males) with mean age of 55.73 years. The outcomes trend of MIO and pain during the follow-up period showed a gradual improvement. Fifty articles meeting the proposed scientific criteria were selected for the literature revision. A range of clinical and procedural variables were analyzed by grouping the studies into two broad categories based on the diagnosis of TMD. CONCLUSIONS: Based on our experience and on the basis of the most accredited scientific studies in the literature, intra-articular injections of HA are beneficial for the improvement of the pain and/or functional symptoms of TMDs.
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Trastornos de la Articulación Temporomandibular , Articulación Temporomandibular , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico , Artrocentesis/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Rango del Movimiento Articular , DolorRESUMEN
In this retrospective case series, patients undergoing surgery to treat isolated orbital floor fractures were morphometrically analyzed. Cloud Compare was used to compare mesh positioning with a virtual plan, using the distance-to-nearest-neighbor method. To assess the accuracy of mesh positioning, a mesh area percentage (MAP) parameter was introduced and three distance ranges were defined as the outcome measures: the 'high-accuracy range' included MAPs at a distance of 0-1 mm from the preoperative plan; the 'intermediate-accuracy range' included MAPs at a distance of 1.1-2 mm from the preoperative plan; the 'low-accuracy range' included MAPs at a distance of >2 mm from the preoperative plan. To complete the study, morphometric analysis of the results was combined with clinical judgment ('excellent', 'good', or 'poor') of mesh positioning by two independent blind observers. In total, 73 of 137 orbital fractures met the inclusion criteria. In the 'high-accuracy range' the mean, minimum, and maximum MAP values were 64%, 22%, and 90%, respectively. In the 'intermediate-accuracy range', the mean, minimum, and maximum values were 24%, 10%, and 42%, respectively. In the 'low-accuracy range', the values were 12%, 1%, and 48%, respectively. Both observers classified 24 cases of mesh positioning as 'excellent', 34 as 'good', and 12 as 'poor'. Within the limitations of the study, it seems that virtual surgical planning and intraoperative navigation has the potential to add quality to the repair of the orbital floor and, therefore, should be taken into consideration whenever appropriate.