Background <p>Total maxillectomy for malignant tumors presents significant challenges for functional and aesthetic rehabilitation. Advances in digital planning and additive manufacturing have reintroduced subperiosteal implants as a promising solution for primary reconstructions.</p> Case report <p>This report details the case of a 59-year-old male with squamous cell carcinoma of the hard palate extending contralaterally, treated with a total maxillectomy and primary reconstruction using an osteomyocutaneous fibula free flap combined with a custom-made, additively manufactured subperiosteal implant. Preoperative planning integrated craniofacial CT scans, dental impressions, and lower limb angiography to design both the implant and fibula cutting guides. The implant, fabricated via direct metal laser sintering, provided a stable framework for fibular segments and future prosthetic rehabilitation. At two years post-surgery, the patient remains disease-free, with no complications and fully functional prosthetic integration.</p> Conclusions <p>This case highlights the feasibility, adaptability, and potential benefits of additively manufactured implants in reconstructing total maxillectomy defects.</p> Clinical trial number <p>N/A</p>