What does the graft replace?
Usually the upper part of the lower jaw near the temporomandibular joint, or TMJ.
The rib bone provides structure, while its cartilage end can help reconstruct the joint region.
Craniofacial & Facial Reconstruction
Costochondral Graft Mandibular Reconstruction
Costochondral graft mandibular reconstruction uses bone and cartilage from a rib to rebuild part of the lower jaw, usually near its joint.
Does this involve two surgical sites?
Yes—the jaw and the chest where the rib graft is taken.
Both areas need follow-up, and chest soreness may affect comfort during recovery.
Can the graft grow with a child?
It may grow, but the amount and direction are unpredictable.
Too much or too little growth can affect the bite and facial balance, so monitoring may continue through skeletal maturity.
01 · Overview
Rebuilding the jaw near its joint
A costochondral graft contains a segment of rib where bone meets cartilage. A surgeon shapes and secures it to reconstruct a missing or damaged portion of the mandible, often the condyle—the rounded end that forms part of the jaw joint.
This operation may be considered for selected developmental differences, injuries or reconstruction after treatment of disease. It is also sometimes used when rebuilding a joint affected by ankylosis, in which abnormal tissue or bone restricts movement. The best approach depends on the remaining jaw, surrounding tissues and prior surgery.
This is not a chin implant, routine bite-correction surgery or an artificial total jaw joint replacement. It rebuilds anatomy with your own tissue. Ordinary TMJ pain does not by itself mean that reconstruction is needed; many TMJ disorders are managed without surgery. [2]
- Graft source
- Your own rib bone and cartilage
- Main treatment area
- Lower jaw near the TMJ
- Anesthesia
- Usually general anesthesia
- Follow-up
- Jaw function, graft healing and growth
Why use tissue from a rib?
A rib provides bone with a cartilage end that can be shaped for the jaw joint region. Its potential for growth can matter in a child, but growth cannot be reliably predicted. The surgeon must weigh this against donor-site risks and other reconstructive options.
Who plans this operation?
Planning usually involves a surgeon experienced in craniofacial or oral and maxillofacial reconstruction. Depending on your needs, orthodontic, dental, rehabilitation and pediatric specialists may also help assess the bite, jaw movement and growth.
02 · Concerns & Goals
What may bring you to a consultation
A difference in jaw development, an injury or previous disease may affect chewing, movement and facial balance. Your goals help guide the discussion.
Limited jaw movement
Stiffness or a fused joint may make opening the mouth, eating and dental care difficult. Reconstruction may be only one part of restoring movement.
Uneven jaw development
A smaller or missing portion of one side of the jaw can affect facial balance and how the teeth meet.
Damage or loss of bone
Injury, disease or earlier surgery may leave a defect that needs structural reconstruction.
Changes during growth
For children, a plan must account for both current function and the possibility of changing jaw proportions over time.
03 · Options
How the approaches differ
The plan depends on the defect, joint condition, age and growth remaining. These are possible components of treatment, not interchangeable choices for every patient.
One-sided reconstruction
Rebuilds the affected side when the opposite joint can be preserved.
How it worksA rib bone-and-cartilage graft is shaped and fixed to the remaining mandible.
May suitSelected patients with a one-sided developmental or acquired defect.
Main tradeoffDifferences between the reconstructed and natural sides may persist or change with growth.
Two-sided reconstruction
Addresses defects involving both sides of the jaw joint region.
How it worksThe surgeon plans reconstruction on each side, including graft needs and bite positioning.
May suitSelected patients with bilateral loss or abnormal development.
Main tradeoffMore extensive reconstruction can add complexity to graft harvesting, bite control and rehabilitation.
Reconstruction with ankylosis release
Combines removal of restrictive tissue or bone with rebuilding the joint region.
How it worksThe surgeon releases the fused area and decides whether a graft and tissue separation are needed.
May suitSome patients with ankylosis and a structural deficit requiring reconstruction.
Main tradeoffStiffness or fusion can recur; a closely supervised movement plan is especially important.
Staged reconstruction
Separates reconstruction from other jaw or bite treatments.
How it worksThe graft may be placed first, with orthodontics or additional jaw surgery considered later.
May suitPatients whose growth, tissue condition or bite makes a single operation less suitable.
Main tradeoffTreatment may involve multiple procedures and a longer overall course.
A bone graft must heal into its recipient site. Graft healing and TMJ symptoms are separate issues, so a structurally successful reconstruction may not resolve every source of pain. [1] [2].
Is an artificial joint an alternative?
In selected patients, especially those who have finished growing, an artificial joint may be considered. Age, previous operations, infection history and the amount of missing bone all matter. Its benefits and risks differ from those of a rib graft.
Would a different bone graft work?
Some defects need another type of bone graft or a bone flap transferred with its blood supply. Larger jaw defects may require a different reconstructive strategy than an isolated defect near the joint.
04 · Results
What may improve and what may remain
Structure and facial balance
The aim is to restore support and improve jaw relationships.
- The result depends on the existing bone, soft tissues and size of the defect.
- Some asymmetry may remain, and additional treatment may be considered.
Movement and bite
Function depends on healing, joint condition and rehabilitation.
- Improved opening or chewing is possible but not guaranteed.
- Dental alignment, muscle stiffness or chronic pain may need separate treatment.
Long-term growth
A child's result can change as the face develops.
- The graft may grow too much, too little or unevenly.
- Later orthodontic treatment or revision surgery may be needed.
Bone graft healing takes time and may require follow-up imaging. Early appearance or comfort does not establish that the graft has fully healed. [1]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery involves both the jaw and chest. Your team's plan should reflect the graft fixation, any joint release, your airway needs and other procedures performed.
Step 1 · Surgery and initial monitoring
Treatment day
The team monitors breathing, pain, bleeding and the bite. Hospital observation may be needed. Ask whether elastics or other jaw restrictions will be used and how they affect communication and eating.
Step 2 · The first days to weeks
Early recovery
Swelling, jaw stiffness and chest soreness are expected. The team gives an individualized plan for food texture, mouth care, wound care and pain control. Ask your surgical team whether compresses are appropriate and exactly how to use them.
Step 3 · Over the following weeks to months
Healing and rehabilitation
Visits assess graft healing, bite position and jaw movement. Exercises may be important, but their timing must balance movement with protection of the reconstruction.
Step 4 · After initial healing; longer during growth
Long-term review
Follow-up checks for graft changes, recurrent stiffness and bite differences. Children may need periodic review through skeletal maturity.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Work or schoolPlanning context: Return depends on pain, fatigue, speaking needs and the treatment plan.What affects it: A return to routine does not mean complete bone healing.
Eating and chewingPlanning context: Food texture and chewing restrictions depend on graft stability and bite management.What affects it: Ask how to meet nutrition needs without loading the reconstruction too soon.
Jaw exercisesPlanning context: Start only according to the surgeon's or therapist's plan.What affects it: Too little movement may contribute to stiffness, while premature force may strain healing tissues.
Lifting, sports and strenuous exercisePlanning context: Both the jaw reconstruction and rib donor site need consideration. [1]What affects it: Clearance depends on healing and the risk of impact or strain.
Follow your surgical team's instructions rather than a general recovery calendar. Ask for separate guidance on jaw activity and chest-related limitations.
Before your procedure
- Review scans, prior operations and dental or orthodontic records with the surgeon.
- Share all medical conditions, medications, supplements and allergies.
- Discuss nicotine use and any changes needed to support healing.
- Ask about anesthesia, airway planning and whether hospital admission is expected.
- Arrange transportation, help at home and time away from work or school.
- Confirm the nutrition plan, rehabilitation arrangements and after-hours contact number.
Will my jaw be wired shut?
Not everyone needs the same bite stabilization. Some plans use elastics or temporary fixation. Ask what is planned, how you will eat and clean your mouth, and what to do if you vomit or have trouble breathing.
Why does the chest need follow-up?
Taking the graft creates a second surgical wound. The team checks pain, the scar and healing, and evaluates any breathing symptoms. Activity restrictions may reflect the donor site as well as the jaw.
06 · Safety
Risks and what your clinician assesses
Temporary facial swelling, bruising, stiffness, altered sensation and chest soreness can occur. Symptoms should be reviewed against your team's expected recovery pattern, especially if they worsen rather than improve.
Bleeding, infection and anesthesia problems
These can occur at either surgical site. Infection may require antibiotics or another operation and can interfere with graft healing.
Failure of graft healing
The graft may not unite with the jaw, may lose volume through resorption or may fracture or shift. Fixation hardware can also cause problems.
Unpredictable growth
Overgrowth, undergrowth or uneven growth can change facial balance and the bite, particularly in children.
Persistent stiffness or recurrent fusion
Opening may remain limited, and ankylosis can recur. Pain may persist even if the reconstructed bone heals.
Nerve, bite and scar changes
Risks include numbness, facial weakness, an altered bite, residual asymmetry and visible scars. Some changes may be lasting.
Rib donor-site complications
Chest pain, contour changes and scarring can occur. Injury to the lining around the lung can cause an air leak or collapsed lung that needs treatment.
Discuss these risks and your individual health history with your surgeon. [1]
What your clinician assesses
- The jaw defect, joint anatomy, mouth opening and bite
- Age, skeletal maturity and remaining facial growth
- Prior surgery, infection, scarring and available rib tissue
- Airway, lung health, nutrition and other factors affecting anesthesia or healing
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope: one or both sides, rib harvesting, joint release, hospital care and any staged procedures. Ask how insurance authorization and separate professional fees will be handled.
Surgeon
Surgical care
Surgeon services for rib graft harvesting and mandibular reconstruction, with any planned additional procedures.
Ask your surgeonAsk whether assistant fees, joint release and later stages are included or billed separately.
Facility
Anesthesia and facility
Anesthesia, operating-room services and planned hospital care.
Ask your surgeonAsk about separate bills and charges if a longer stay is needed.
Supplies
Supplies and follow-up
Potential charges for fixation materials, imaging, medications and postoperative visits.
Ask your surgeonConfirm whether rehabilitation, orthodontics and long-term growth monitoring are included.
TRC
Patient Services
Any separately listed administrative or care-coordination services.
Ask TRCAsk which services are optional, who provides them and whether they are covered by insurance.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Is this the same as jaw advancement surgery?
No. Jaw advancement repositions existing jaw bone. A costochondral graft replaces or rebuilds part of the jaw with rib bone and cartilage. Some patients need both types of treatment at different stages.
Will this cure TMJ pain?
Not necessarily. Reconstruction addresses a structural problem, while pain can also come from muscles, nerves or other joint changes. Ask which symptoms the operation is expected to address.
Will the rib grow back?
Some bone regeneration may occur after rib harvesting, but complete regrowth is not assured. Ask about the planned harvest, chest contour and donor-site risks.
Could another operation be needed?
Yes. Growth changes, graft problems, recurrent stiffness or bite differences may require further treatment. Long-term follow-up helps identify these changes.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Understand the reconstruction, alternatives and possible need for later treatment.
- Have a personalized plan for food, mouth care, activity and rehabilitation.
- Confirm follow-up visits, urgent contact instructions and written costs.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]Cleveland Clinic: Bone GraftGeneral bone-graft healing, infection and graft-failure risks, recovery monitoring and reasons to contact the care team; not the full set of costochondral graft-specific risks.
- [2]Mayo Clinic: TMJ disorders—Diagnosis and treatmentAssessment of TMJ symptoms, nonsurgical treatment options and selective use of surgery; does not establish suitability for costochondral reconstruction.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.