The zygomatic and maxillary bones provide contour and symmetry to the face. Due to their morphologic prominence, they are the second most commonly fractured sites after the nasal bone [
1]. The fractured zygomatic bone is usually dislocated in an inferomedial and posterior direction, resulting in a cosmetic deformity with loss of the ipsilateral malar eminence, possible depression of the zygomatic arch, asymmetry of the bony orbital circumstance, and possible enophthalmos [
2,
3]. For the most accurate reduction of a zygomatic fracture, the zygomaticofrontal articulation, infraorbital rim, and zygomaticomaxillary buttress should be exposed and properly aligned. Once alignment of these articulations has been achieved, accurate reduction of the fracture to its anatomical location can be performed [
6]. Building on Karlan's concept of the zygoma as a pyramid, we have imagined the zygomatic complex as a 3-D shape with three axes intersecting at the malar eminence (
Fig. 3). The x-axis (horizontal axis) is represented by a line through the inferior orbital rim and extending horizontally onto the surface of the zygomatic arch. The y-axis (vertical axis) is represented by a vertical line extending from the frontozygomatic suture line inferiorly along the lateral wall of the orbit. The z-axis is represented by a line drawn perpendicular to the malar eminence and parallel to the lateral wall of the orbit [
1,
7]. An ideal reduction using this analysis applies both linear and rotary forces in the opposite direction of the original injury. For example, medially rotated body fractures (group IV, Knight and North Classification) appear to be caused by a blow to the malar eminence from above the horizontal axis of the bone [
4]. This also drives the bone backwards, inwards, and downwards, and for a right malar fracture, with a clockwise rotation. For reduction, we pull the zygomatic complex around the z-axis and then rotate the entire complex in the opposite direction by pivoting it around the y-axis. The most important aspect of the treatment of zygomatic complex fractures is careful exposure of all the fractures and their accurate reduction in a 3-D fashion [
8]. Facial symmetry is achieved by restoring the 3-D position of the malar prominence, and orbital volume is restored by the zygomaticosphenoid alignment at the lateral orbital wall. Many methods and objects have been used to set the zygomatic [
9] fractures into an anatomic position such as towel clips, hemostats and clamps, bone hooks, and a variety of elevators [
3]. With most techniques, reduction is difficult, inaccurate, and impossible to maintain because orbital fractures involving some or all of the zygomatic articulations (zygomaticosphenoid, zygomaticofrontal, zygomaticomaxillary, and zygomaticotemporal) are commonly encountered [
4,
8]. In our experience, the application of bone elevators or towel clips is limited by the ability of the surgeon to titrate force along all three dimensions. The use of the Carroll-Girard T-bar fixation screw solves such problems by allowing the precise manipulation and anatomic reduction of zygomatic fractures. The T-bar screw is easy to use and rotatable to any direction [
7]. Despite these benefits, many surgeons are unwilling to use the device because they are accustomed to using percutaneous stab incisions to expose protruding parts of zygomatic bones. In our patients, fractured bone was exposed through a lateral brow, intraoral, and subciliary incision, which allowed us to visualize the fractures and then correct them using the T-bar screw. Because this method allowed us to quickly exert concentrated force directly to the fractured parts, compound zygomatic fractures were more accurately and safely corrected in all of our patients, without leaving facial scars.