The conflict in the Middle East has led to an increase in the incidence and severity of facial trauma evaluated at tertiary military medical facilities. The Naval Medical Center San Diego, San Diego, Calif, has treated 5 patients with penetrating injuries to the orbit with associated comminuted fractures. We have used the technology of image-guided surgery to assist in reconstructing these injuries. Image-guided surgery has many applications in the head and neck. This review consists of a series of traumatic applications of the image-guided system with a focus on orbital and midfacial trauma. We will discuss the benefits and drawbacks of this technique compared with previously described techniques.