The mandible and temporomandibular joint (TMJ) are critical to the functional integrity of the face.  As a hinge for powerful mandibular structures, the TMJ allows for proper mastication, speech production, and facial expression. However, in severe cases of ankylosis, congenital disease, neoplasia or post-traumatic dysfunction, the TMJ may become significantly dysmorphic and nonfunctional.^{1, 2}  In order to restore a proper environment for oral development, mastication, proper occlusion, and speech, early correction is necessary.  Though the use of costochondral grafts for mandible and TMJ reconstruction is well-established particularly in children due to its growth potential, disadvantages include the relatively poor quality of bone, and suboptimal structural integrity.³  The inferior osteoinductive capacity and poor rigidity of this graft may contribute to screw loosening, hardware failure, and compromised graft integrity sometimes seen clinically.  Prompted by a need for improved bone quality of the reconstructed region, we created a composite mandibular graft consisting of both costochodral and iliac graft material.  In our experience, TMJ reconstructions utilizing this combination in conjunction with plate fixation improves structural stability and produces superior a clinical outcome.