When shaving or rasping the nasal bump down on the nose, where does the bone go?

Hi there,Good question, thank you.Rasping the nasal bones is an interesting technique with many pitfalls. There are a couple of parts to your question.Firstly, most of the rasped bone does attach to the rasp.  Living bone is slightly soft and sticky, unlike the dried bone you would see on a skull or skeleton for example.  But there are bone fragments left in the nose, and unless they are carefully flushed out with sterile saline irrigation they can cause problems. Usually after a rhinoplasty, the bone just heals as it is left by the surgeon.  But bone fragments are very osteogenic - that is they encourage new bone to form. So if bone fragments are left in the nose they can encourage a new bump to form. I've seen this. It can even cause osteitis, which encourages new bone to form in unwelcome spots. In the longer run, any dust like fragments of bone left in the nose would most likely be resorbed by the body. Larger fragments or splinters not taken out can remain, as a feelable and visible bump. In summary, carefully removing fragments and irrigating the nose to flush the dust out is very important.The second part of the question is smoothing the nose with a rasp.  I rarely use a rasp actually.  I prefer a very sharp osteotome, which is like a little chisel.  The reason for this is that when rasping the nose, we are usually rasping the bone - cartilage junction, not just the bone.  The rasp seems to prefer bone.  So it is easy for the inexperienced to over rasp the nasal bones, while leaving more cartilage than intended as the rasp might just run over it rather than rasp it down. I fine a sharp osteotome is much more accurate and controlled than a rasp.Having said that, many surgeons prefer a rasp and there is nothing wrong with that. Skilled control of a sharp rasp is important to achieve a smooth dorsum and accurate removal of the hump, and that can be done with a rasp if that is the surgeons preference.Hope this is of interest.Howard Webster.

This is a very astute question. The bone fragments tend to stick to the rasp itself and are removed. The wound is also suctioned and any visible or palpable fragments are taken out. An irregularity on the bridge of the nose resulting from a left behind bone fragment is very uncommon. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Rasping alone may be enough to effectively manage a nasal hump but if larger , the hump is removed with an osteotome (chisel)  then any residual prominence  removed with a rasp.The bone is attached to the rasp which is repeatedly cleaned during the rasping procedure.  I have not had problems with retained fragments.  With reassessment and visualization after rasping,  minor fragments may be suctioned from the operative site  

The dorsal hump is composed of both bone and cartilage. To remove the cartilage, it must be cut with a knife or scissors. The bone is usually cut with an osteotome and entire hump removed  together as one piece. Once the hump is removed, minor adjustments are made with a rasp to file down  any minor residual irregularities. The small " sawdust" is removed with the filing  because  the rasp is grooved to pull the fragments outward. A final irrigation and cleaning of the bridge line and underneath the skin is performed to remove any residual material.  For  many examples of dorsal hump removal in our practice, please see the link and video below

Thank you for the question.  After a file or rasp is used to file down a bump, it is rinsed in sterile saline which gets rid of most of the bone fragments or powder.  The area is also irrigated with sterile saline before closing the incisions.  This will get rid of majority of any fragments made by the rasp.  In all honesty, the fragments even if left behind are usually not large enough to cause any issues in healing or aesthetics. 

The small bony fragments are more like bone dust than bone splinters, and they wash off when the rasp is rinsed in a container of sterile saline. Saline is also used to flush out the wound. A bone dust fragment would be too small to be detectable. Click on the link below to see a bony hump that was rasped.

When using a rasp to to shave down bony irregularities in rhinoplasty, I typically remove the fine bony fragments on the rasp face and wipe them off on a moist gauze.  Some surgeons may irrigate the nose with a saltwater solution to ensure removing any bony fragments.  In a patient with a pronounced nasal hump/ bump, I usually employ some other instruments (such as an osteotome and/ or a Joseph saw) to take down the bone and cartilage of the hump, and use the rasps to smooth out any irregularities.  Irregularities in the post-rhinoplasty nose have a variety of causes, including a history of trauma, excessive scar tissue, and rarely, bone/ cartilage fragments.  Small touch-up procedures (such as shaving down a nasal irregularity) are not too unusual in the rhinoplasty surgeon's practice.  I recommend establishing a good rapport with an experienced rhinoplasty surgeon, and addressing your concerns with him/ her.  A discussion about post-operative care, healing, and the surgeon's revision rates may prove quite helpful.  Good luck!