# Endonasal Endoscopic Approach for Bone Spicule Removal: A Case Report

## TL;DR

A minimally invasive endonasal endoscopic approach successfully removed a bone spicule causing nasal swelling after rhinoplasty.

## Contribution

The paper introduces the endonasal endoscopic approach as a novel, minimally invasive method for removing overlooked bone spicules post-rhinoplasty.

## Key findings

- The endonasal endoscopic approach effectively extracted a bone spicule with no skin scar or postoperative complaints.
- Precise osteotomies using sharpened tools and intraoperative detection can prevent bone spicule formation and complications.
- Minimally invasive techniques like EEA offer a practical solution for late-presenting bone spicule issues.

## Abstract

During rhinoplasty surgery, tiny bone spicules (BSs) can form, particularly if blunt tools are used. If these BSs are not noticed and removed intraoperatively, they can cause cosmetic problems and nasal swelling postoperatively. A patient who underwent open rhinoplasty 2 years ago presented with a painless swelling causing cosmetic problems near the left medial canthus. A BS was detected by paranasal sinus computerized tomography and removed using an endonasal endoscopic approach (EEA). At 13 months of postoperative follow‐up, the patient reported no complaints. The use of sharpened osteotomes or powered instruments, capable of creating the precise and desired osteotomies, is crucial to prevent the formation of BS. Detecting these BS intraoperatively is also desirable. Administering intravenous corticosteroids, such as prednisolone (1 mg/kg), maintaining hypotensive anesthesia, applying ice packs, and elevating the head 30° during surgery can help reduce edema and aid in the identification of BS. Saline irrigation and surgical field aspiration can facilitate the removal of BS. Final inspection and palpation of the nose from different angles under proper lighting are essential. In cases where BSs are overlooked, an EEA with minimal dissection and no skin scar may be preferred for their extraction. EEA is a minimally invasive, practical, and successful treatment option for BS extraction.