BACKGROUND: Craniofacial injuries secondary to earthquake-related trauma are uncommonly reported and can pose a significant reconstructive challenge. The objective of this study is to report and analyze earthquake-related craniofacial injury reconstruction and the disaster relief capabilities of a U.S. Navy hospital ship. METHODS: A review of earthquake-related injuries treated over 40 days requiring craniofacial reconstruction onboard a U.S. Navy hospital ship was performed. RESULTS: From January 20 to February 28, 2010 (40 days), 869 patients were admitted to the USNS Comfort. Thirty-three patients (4 percent) treated by the craniofacial service underwent 93 craniofacial surgical procedures. Average patient hospitalization time was 17 days (range, 5 to 38 days). The fractures treated included nine mandibles, 12 zygomaticomaxillary-orbital complexes, 16 orbital floors, eight Le Fort, four naso-orbitoethmoid, and two cranial vault fractures. The soft-tissue injuries treated were two heminasal avulsions, two traumatic cleft lips, and eight other complex facial lacerations. Short-term complications included wound dehiscence (6 percent) and postoperative malocclusion (6 percent). There were no postsurgical wound infections, visual field changes, or mortality. CONCLUSIONS: Complex craniofacial surgery services can be safely delivered onboard a United States Navy hospital ship for devastating injuries caused by natural disasters. Although craniofacial injuries represented a small percentage of the total patients admitted to our hospital ship, the survivors of facial injury required complex and multiple procedures to achieve optimal results. Despite heavy wound contamination and the intrinsic delay in presentation associated with mass casualty triage, facial fractures can be treated adequately and with low morbidity and mortality.