The totem pole rib graft reconstruction of the nose.

The totem pole rib bone graft for nasal reconstruction is presented as an effective way to prepare the donor bone for the correction of saddle-nose deformity. The article's title emanates from the fact that when the sculpturing of the rib is completed it has the appearance of a totem pole before the separate parts are disarticulated for insertion into the nose. The use of this technique permits an accurate, detailed sculpturing of the component parts of the subsequent reconstruction, permitting correction of each feature of the saddle-nose deformity. If these bony segments were dissected or sculptured separately, the smallness of each part would make it very difficult to carve the precise definition needed for a reconstruction that would give structural support and at the same time afford an aesthetically pleasing result. The rationale of the technique and representative cases are presented.