Background: This study evaluates the efficacy of preoperative versus intraoperative mandibular contouring using rapid prototyping technology. Methods: 10 patients requiring mandibular reconstruction had a preoperative mandibular plate contoured to a fabricated three-dimensional mandibular model based on preoperative imaging. A traditional intraoperative plate was also contoured. Two blinded surgeons compared the plates with respect to conformance, surface-area contact, and best overall match. A cost-benefit analysis was then performed. Results: The average time to contour was 867+/-243 seconds and 833+/-289 seconds for the preoperative and intraoperative plates respectively(p=0.83). Inter-observer analysis revealed no statistically significant differences in conformance(p=0.38) or surface area contact(p=0.14). In 7/9 cases, the preoperative plate was selected for the final reconstruction. In one case, an intraoperative plate was not contoured due to the lateral extent of the tumor. Conclusions: In cases of mandibular distortion secondary to disease, pathologic fracture or defects involving multiple mandibular subsites this method is particularly advantageous. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.