The zygomatic bone plays a pivotal role in determining the anterior and lateral projections of the midface and the proper placement of the globe. Securing primary anatomical reduction of zygomatic fractures is critical, as secondary reconstruction is substantially more difficult. Addressing a malpositioned zygoma requires osteotomy of the healed bone to facilitate repositioning. Owing to the zygoma’s profound influence on midfacial contour, achieving meticulous three-dimensional realignment is paramount. Contemporary technological progress is accelerating, paving the way for enhanced outcomes across a wide array of surgical specialties, and the utilization of bespoke surgical guides and fixation hardware is gaining widespread traction. By applying 3D segmentation and design platforms, we formulated a sequential workflow that leverages three-dimensional planning and additive manufacturing for the refracturing step—circumventing the need for coronal exposure—and for the precise repositioning and stabilization of the zygoma in its corrected location. The methodology is delineated alongside a novel, sophisticated 3D analysis that permits objective evaluation of surgical outcomes. Two clinical cases are detailed, covering both the design phase and the postoperative morphological alterations. A comparative analysis of the preoperative, virtually planned, and final achieved positions revealed a degree of accuracy that effectively eliminates the risk of human error inherent in a three-dimensional-sensitive intervention such as zygomatic refracturing. This protocol lends itself readily to adaptation across other realms of secondary reconstruction, necessitating skeletal realignment.
