To our knowledge, the imaging features of costochondral grafts (CCGs) on cone-beam computed tomography (CBCT) have not been documented in the literature. We present the case of a CCG in the facial soft tissue to the anterior mandible, with changes mimicking a cartilaginous neoplasm. This is the first report to describe the CBCT imaging features of a long-standing graft in the anterior mandible. Implants or grafts may be incidental findings on radiographic images made for unrelated purposes. Although most are well-defined and radiographically homogeneous, being of relatively inert non-biological material, immune reactions to some grafts may stimulate alterations in the appearance of surrounding tissues. Biological implants may undergo growth and differentiation, causing their appearance to mimic neoplastic lesions. We present the case of a cosmetic autogenous CCG that posed a diagnostic challenge both radiographically and histopathologically.