Machinery-related fatalities are one of the leading causes of traumatic occupational deaths. In our report, we present the case of a 40-year-old male who suffered a severe head trauma while working in a cut-foam industry and died despite an early craniectomy. The radiological reconstruction of the skull based on preoperative computed tomography scans disclosed a large depressed conical fracture of the left parietal bone. The 3D-reconstruction of the work area, combined with a fit-matching analysis between the machinery and the depressed skull fracture allowed us to conclude that the head was crushed between the sliding bar of the cutting device and the metallic protuberance on the opposite side. The case underlines the importance of a detailed workplace investigation and of a thorough evaluation of all circumstantial, clinical, radiological, and autopsy data in the reconstruction of machinery-related fatalities to identify any possible legal responsibilities of the worker and/or the employer.