Clinical outcomes for minimally invasive primary and secondary orbital reconstruction using an advanced synergistic combination of navigation and endoscopy Chien-Tzung Chen a,b, *, Chun-Hao Pan a , Chih-Hao Chen c , Victor Bong-Han Shyu c , John Chung-Han Wu c , Gavin Chun-Wui Kang d a Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan b Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung University, College of Medicine, Taoyuan, Taiwan c Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan d Department of Plastic, Reconstructive, and Aesthetic Surgery, KK Women’s and Children’s Hospital, Singapore Received 7 December 2016; accepted 14 August 2017 KEYWORDS Primary and secondary traumatic orbit reconstruction; Minimally invasive surgery; Advanced technology; Computer-assisted surgery; Endoscopic image- guided surgery Summary Background: Sequelae of inadequate orbital reconstruction include enophthal- mos, hypoglobus, and diplopia. Accuracy of orbital reconstruction is largely subjective and especially difficult to achieve because of anatomic distortion in secondary or late reconstruc- tion and in extensive injury. We combined computer navigation and endoscopy to perform ac- curate, aesthetic, and safe minimal-access primary and secondary orbital reconstruction. Methods: From 2013 to 2014, 24 patients underwent unilateral primary and secondary or late minimally invasive orbital reconstruction with mainly Medpor and/or titanium mesh by naviga- tion and endoscopic assistance through transantral, transconjunctival, or upper blepharoplasty approaches. Mean follow-up was 13.8 months (range, 6.2 months to 2.8 years). Results: All orbital fractures were successfully reduced. Average enophthalmos among pa- tients who underwent early reconstruction, late reconstruction, and multiorbital wall repair improved (p < .001) to 0.2 mm from 1.6, 2.6, and 2.6 mm, respectively. Hypoglobus and diplopia resolved in all. In early reconstruction patients, mean interorbital volume difference improved from 1.72  0.87 to 0.53  0.83 ml (P Z .03). For late reconstruction patients, this * Corresponding author. Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, 222, Maijin Road, Keelung 20401, Taiwan. E-mail address: ctchenap@cgmh.org.tw (C.-T. Chen). + MODEL Please cite this article in press as: Chen C-T, et al., Clinical outcomes for minimally invasive primary and secondary orbital reconstruction using an advanced synergistic combination of navigation and endoscopy, Journal of Plastic, Reconstructive & Aesthetic Surgery (2017), http://dx.doi.org/10.1016/j.bjps.2017.08.018 http://dx.doi.org/10.1016/j.bjps.2017.08.018 1748-6815/ª 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Journal of Plastic, Reconstructive & Aesthetic Surgery (2017) xx,1e11