Classical vs. Customized Post-Traumatic Orbital Reconstruction with ‘In-House’ 3D-Printed Models: An Extended Cohort Study with Volumetric Analysis

Background: Orbital floor fractures (OFFs) represent a challenging reconstructive problem because of the complex three-dimensional anatomy of the orbit. Building upon our group’s 2024 preliminary pilot study, which initially proposed an “In-House” digital framework, this retrospective study aims to definitively validate and scale up that protocol.Methods: This retrospective single-center comparative cohort study evaluated an in-house workflow, on patients treated for OFF at the “Magna Graecia” University Hospital of Catanzaro from 1 January 2022 to 31 December 2025, in which titanium mesh was pre-contoured on a patient-specific 3D-printed stereolithographic model, compared with conventional intraoperative manual contouring.Results: Twenty-nine patients met the surgical inclusion criteria: 7 were treated conventionally (G1a) and 22 with the 3D-planned workflow (G1b). Twenty-nine patients with intact orbital structures served as a descriptive control cohort (G2). In G1, 87 volumetric measurements were obtained: preoperative measurements of the healthy contralateral and fractured orbits and postoperative measurements of the reconstructed orbit. The primary comparative volumetric outcome was the absolute postoperative residual discrepancy between the reconstructed orbit and the healthy contralateral orbit. Because of the small and unequal groups, the comparison between G1a and G1b was performed using an exact two-sided Mann–Whitney U test. G1b showed a lower median absolute postoperative residual discrepancy than G1a (0.4668 vs. 1.3370 cm3; U = 139; p = 0.00072). Operative time was also shorter in G1b (mean 41.4 vs. 80.7 min; exact Mann–Whitney p < 0.00001). The control cohort showed a mean absolute inter-orbital difference of 0.6177 ± 0.29 cm3; the interval 0.3277–0.9077 cm3 represents mean ± SD and is reported only as an exploratory descriptive band, not as a validated clinical reference interval or therapeutic threshold. All G1b patients had resolution of diplopia by one year, but the observational design does not establish a causal relationship between a specific volumetric value and functional recovery.Conclusion: These findings suggest an association between the in-house 3D workflow and improved volumetric matching and shorter operative time, while the small conventional subgroup and temporal differences between treatment periods require confirmation in larger prospective studies.