Beyond Orbital Volume: Outcomes of Patient-Specific Implants, Surgical Navigation, and Artificial Intelligence in Orbital Reconstruction

Orbital reconstruction increasingly incorporates patient-specific implants (PSIs), surgical navigation, and artificial intelligence (AI), but the clinical value of these technologies depends on more than geometric accuracy.This critical narrative review examines their effects on globe position, binocular function, visual safety, and patient experience, principally in adult post-traumatic reconstruction.Literature identification used targeted PubMed and Europe PMC searches, publisher sources, and citation tracing, covering publications through September 2026; targeted source verification during revision was undertaken on 10 October 2026.Selection was purposive rather than systematic.Earlier meta-analyses found inconsistent comparative benefits, whereas a newer systematic review reported favorable descriptive summaries for persistent enophthalmos, diplopia, and revision.These summaries should not be interpreted as pooled causal effect estimates.A small randomized trial supports improved volumetric accuracy with directly manufactured implants but does not establish durable functional superiority.Navigation may assist complex reconstruction, although co-interventions and selection bias limit attribution of benefit.A small contemporary polyether ether ketone (PEEK) implant cohort found no statistically demonstrable incremental navigation advantage.AI primarily demonstrates performance in detection, segmentation, and virtual reconstruction, with postoperative benefit remaining uncertain.Outcome heterogeneity, incomplete reporting, and limited follow-up restrict comparisons.Selective use according to the reconstructive difficulty is reasonable, but proposed selection frameworks remain unvalidated.Prospective comparisons should measure standardized functional, patient-reported, safety, and economic outcomes alongside anatomical accuracy.