Background: Specialized skills are required in the management of paediatric airway conditions, such as open airway reconstruction. Surgical simulation allows a means to practise and master these advanced skills within a safe environment. This study presents the use of three-dimensional (3D) printing and computer-aided design (CAD) to create a high-fidelity simulator for developing the skills of carving costal cartilage grafts for airway reconstruction. Methods: In a prospective observational study, participants completed a physical simulator exercise using a 3D-printed assisted costal cartilage grafting tool. A Likert-scale questionnaire was used to evaluate its usefulness as a training model. Results: There were 46 participants, of which 58.7% had not participated in an airway reconstruction procedure or had cartilage grafting experience. More than half of participants were post-graduate year (PGY) ≥7 [30.4% surgical education and training (SET) trainees, 4.3% fellows and 26.1% consultants]. Over two thirds of participants who had prior laryngotracheal reconstruction (LTR) experience believed the cartilage realism was adequate; and a further 25% found it to be highly realistic. Majority of participants found it to be both a valuable training tool (95%) and relevant to their practice (84.6%). Conclusions: This Australian study demonstrates the use of 3D printing technology to create a rapidly producible, low-cost physical simulator for cartilage graft carving in airway reconstruction.