As karst systems are natural windows to the underground, speleology, combined with geological surveys, can be useful tools for helping understand the geological evolution of karst areas. In order to enhance the reconstruction of the structural setting in a gypsum karst area (Vena del Gesso, Romagna Apennines), a detailed analysis has been carried out on hypogeal data. Structural features (faults, fractures, tectonic foliations, bedding) have been mapped in the ”Grotta del Re Tiberio” cave, in the nearby gypsum quarry tunnels and open pit benches. Five fracture systems and six fault systems have been identified. The fault systems have been further analyzed through stereographic projections and geometric-kinematic evaluations in order to reconstruct the relative chronology of these structures. This analysis led to the detection of two deformation phases. The results permitted linking of the hypogeal data with the surface data both at a local and regional scale. At the local scale, fracture data collected in the underground have been compared with previous authors’ surface data coming from the quarry area. The two data sets show a very good correspondence, as every underground fracture system matches with one of the surface fracture system. Moreover, in the cave, a larger number of fractures belonging to each system could be mapped. At the regional scale, the two deformation phases detected can be integrated in the structural setting of the study area, thereby enhancing the tectonic interpretation of the area (e.g., structures belonging to a new deformation phase, not reported before, have been identified underground). The structural detailed hypogeal survey has, thus, provided very useful data, both by integrating the existing information and revealing new data not detected at the surface. In particular, some small structures (e.g., displacement markers and short fractures) are better preserved in the hypogeal environment than on the surface where the outcropping gypsum is more exposed to dissolution and recrystallization. The hypogeal geological survey, therefore, can be considered a powerful tool for integrating the surface and log data in order to enhance the reconstruction of the deformational history and to get a three-dimensional model of the bedrock in karst areas.