When developmental, traumatic, neoplastic arthritis or ankylosis results in an anatomically unsalvageable, functionally compromised temporomandibular joint (TMJ), total joint replacement (TJR) may provide the only management option. In the adult patient these situations are often dealt with by use of either autogenous or alloplastic modalities. However, any of these pathologic conditions when present in the growing patient present the reconstructive surgeon with not only the concerns of form and function, but also the consideration of adaptive facial growth. 1-3 Classically, pathologic, developmental, and functional disorders affecting the TMJ in children have been reconstructed with autogenous tissues. Autogenous costochondral grafts are reported as the “gold standard” for TMJ reconstruction in the growing patient. 4-8 The use of other autogenous bone/cartilage combinations has also been described in such cases. 9-12 In theory, these autogenous (eg, costochondral) allografts will “grow with the patient”; however, often, this so-called growth potential has been stated to be unpredictable or to result in ankylosis, either as the result of the allograft and/or fixation failure or because of the uncooperative nature of the young patient with physical therapy after reconstruction. 4,5,13-28 Recent studies have even questioned the necessity for using a cartilaginous graft to restore and maintain mandibular growth. 29,30 Long-term reports of mandibular growth in children whose TMJs were reconstructed with costochondral grafts show that excessive growth on the treated side occurred in 54% of the 72 cases examined, and growth equal to that on the opposite side occurred in only 38% of the cases. 26,31-35 Further