Recently, the temporomandibular joint has been reconstructed with a variety of alloplastic materials; however, functional results are often limited, and long-term stability of the reconstruction is questionable. In contrast, costochondral rib grafting with rigid internal fixation and a temporoparietal fascia flap allows complete functional reconstruction of the temporomandibular joint with autogenous tissue. Thirteen joint reconstructions in 11 patients were followed for up to 7 years and stability of the reconstruction was confirmed. The anterior incisal opening improved from a mean of 14 to 31 mm. Normal occlusal relationships were either reestablished or preserved. Joint pain was ameliorated. The preferred reconstruction of the temporomandibular joint is by autogenous tissue for disc and joint replacement. The treatment provides primary therapy in total joint reconstruction where tumor, trauma, or failed prosthetic joint replacement necessitate complete reconstruction.