Background and objectives : The aim of this study is to assess the predictability of the result of reconstruction of orbital fractures in relation to defect size and location.

Methods : A systematic literature search in PubMED (all indexed years) with multiple search terms was performed, combining the subjects “orbital fracture”, “reconstruction material”, “volume” and “classification”.

Results : 236 studies met the primary inclusion criteria. In total 14,353 patients with orbital injuries were identified. 228 studies were evaluated in full tekst. Only 17 manuscripts met the criteria for a prospective study, of those 4 RCT’s, 2 CCT’s, 13 Cohort studies were performed on the subject orbital reconstruction. An actual defect size and location were sparsely described. Only one study focused on reconstruction of large orbital defects (Jacquiery III/IV).

Conclusions : Small defects are known to heal solely by the formation of scar tissue, whereas larger defects associated with enophthalmos and hypoglobus need rigid reconstruction material to support the orbital contents and retain the contour of the orbit. Small sample sizes and heterogeneous diagnoses prevent firm conclusions on “defect driven reconstruction”. Future systematic studies would greatly benefit from a clinical and radiographic classification system of orbital fractures. Predictability might increase when three-dimensional anatomical and physiopathological aspects are taken into consideration. Sophicated techniques might help the surgeon to reach defect driven choices on surgical methods and reconstruction, form and material.

Key words: orbital fracture; orbital reconstruction; trauma