Nasally ectopic teeth are rare, but can be a source of significant morbidity. Symptoms can include facial pain, nasolacrimal duct obstruction, fungal rhinitis, persistent rhinorrhea and episodic epistaxis. A nasally ectopic tooth should be considered as a differential diagnosis for a radiopaque lesion within the nasal cavity. This case illustrates the diagnosis and subsequent minimally traumatic recovery of a nasally ectopic tooth, believed to be an upper first premolar tooth, via an endoscopic approach.