Background <p>Precise placement of bone grafts is critical for functional and aesthetic outcomes in mandibular reconstruction. Conventional positioning guides typically require extensive stripping of periosteum and surrounding soft tissues, which may increase surgical trauma. This pilot study aimed to assess the feasibility and preliminary clinical performance of a novel soft tissue–sparing positioning guide for mandibular reconstruction.</p> Methods <p>This single-arm case series feasibility study included five female patients with segmental mandibular defects. Preoperative computed tomography data were used for virtual surgical planning and fabrication of patient-specific osteotomy and positioning guides using three-dimensional printing. The novel positioning guide featured an arched structural design that maintained a predefined clearance from the bone graft surface, allowing accommodation of periosteum and muscles while ensuring standardized and accurate fixation. Postoperative outcomes were evaluated using serial imaging and three-dimensional deviation analysis of six bilateral mandibular anatomical landmarks.</p> Results <p>All patients completed the surgical protocol without flap loss or severe complications. Minor postoperative morbidity was limited to transient donor-site edema, and no permanent sensory deficits, local recurrence, or metastasis were observed during follow-up. Intraoperative findings confirmed effective preservation of soft tissues around the bone graft, except at the precision fixation part. Quantitative three-dimensional analysis demonstrated satisfactory postoperative mandibular alignment across all evaluated landmarks.</p> Conclusions <p>The proposed soft tissue–sparing positioning guide appears to be a feasible adjunct for mandibular reconstruction based on the findings of this preliminary study, but given that this is a small, uncontrolled feasibility case series, further validation in larger controlled studies is warranted.</p>