Custom nasal septal buttons can provide a prosthetic option for selected patients with symptomatic septal perforations, particularly where a standard prefabricated button does not fit well or surgery is not currently preferred. One published technique used computed tomography (CT) to map the perforation and surrounding anatomy so that a custom Silastic button could be made to fit the individual defect.
A Septal Button Covers the Opening — It Does Not Heal It Closed
A septal button is a prosthetic device positioned through the perforation so that a flange rests on each side of the septum. The aim is usually to reduce airflow through the opening and improve symptoms while leaving the underlying perforation anatomically present.
Reversible
A button can usually be adjusted, replaced or removed if it is not tolerated or if treatment goals change.
Individually Fitted
Custom fabrication can be useful when the shape or size of a perforation makes a standard button difficult to fit securely.
Symptom-Focused
The purpose is symptom management rather than biological reconstruction of the missing septal tissue.
Not Suitable for Everyone
Comfort, tissue condition, perforation position, surrounding support and individual anatomy all influence whether a button is appropriate.
Why Standard Septal Buttons Do Not Fit Every Perforation
Septal perforations vary in size, shape, position and surrounding tissue configuration. Large or irregular perforations may therefore be difficult to cover with a standard prefabricated button.
Irregular Shape
A circular or standard-sized prosthesis may not sit evenly around a defect that has an irregular outline.
Larger Defects
Larger perforations may require wider or differently shaped flanges to achieve a stable fit around the remaining septal tissue.
Individual Nasal Anatomy
The space available inside the nose differs between patients, so comfort depends on more than the diameter of the opening alone.
Previous Surgery
Scar tissue, altered cartilage and previous reconstruction can change the anatomy around the perforation and influence prosthetic fitting.
How CT Was Used to Make a Custom Septal Button
A 2003 retrospective series described a method in which CT images were used to map the perforation and surrounding soft tissue before a custom Silastic button was fashioned for the patient.
CT Assessment
The published protocol used non-contrast CT with thin axial sections. Reformatted sagittal and coronal views were used to define the perforation and the surrounding anatomy.
Map the Defect
Reformatted images were used to reproduce the dimensions and contour of the perforation so that the prosthesis could be planned around the actual defect.
Fabricate the Button
A custom Silastic prosthesis was fashioned from the measurements, including flanges intended to rest against the septal tissue around the opening.
Insert and Check the Fit
The buttons in the study were inserted under local or general anaesthesia. Position and fit were assessed during placement and could be adjusted where necessary.
The study described CT as part of a particular custom-fabrication technique. It should not be interpreted as a recommendation that every patient with a septal perforation needs CT imaging. Investigation and imaging should be based on the clinical circumstances and the treatment being considered.
What Did the Published CT-Guided Series Report?
The original study involved 95 patients who were fitted with custom septal buttons. Follow-up longer than one month was available for 74 patients, with follow-up ranging from one month to 17 years.
Patients were fitted with custom CT-guided Silastic septal buttons.
The average reported diameter was 2.6 cm.
Among the followed patients, epistaxis was reported as improved or resolved in 77%.
Nasal crusting was reported as improved or resolved in 59% of followed patients.
Difficulty breathing was reported as improved or resolved in 60%.
The paper reported that 56 of 65 buttons, after excluding buttons removed because of patient intolerance, remained in place for longer than five years or until the latest follow-up.
The denominator excludes patients whose buttons were removed because they could not tolerate them. The study was also retrospective and reflects a selected group treated with a specific technique. The figure should therefore be read as a retention result within that study rather than a guarantee of outcome for an individual patient.
Custom Does Not Mean Maintenance-Free
Septal buttons can be helpful, but they are still foreign-body prostheses and may require review, adjustment, replacement or removal.
- Some patients do not tolerate the sensation of a button inside the nose.
- Crusting can continue despite placement.
- Infection or local irritation may occasionally require treatment or removal.
- A button can move, wear or break down over time.
- Changes in the perforation or surrounding tissue can alter the fit.
- Follow-up is important if symptoms recur or the device becomes uncomfortable.
A 2025 retrospective UK audit of 77 patients treated with prefabricated Silastic septal buttons reported that 39 required no further intervention, while others required one or more replacements, adjustment or removal. The study involved a different button technique from the CT-guided custom series, but it reinforces the point that prosthetic management often requires ongoing follow-up.
Who Might Be Considered for a Septal Button?
A septal button may be discussed when symptoms remain troublesome and a prosthetic approach is considered more appropriate than reconstructive surgery at that stage.
Surgery Is Not Preferred
Some patients prefer to avoid reconstructive surgery or are not ready to consider it.
Surgery Is Not Suitable
Tissue condition, underlying disease, previous operations or other health factors may influence whether surgical repair is appropriate.
Standard Buttons Fit Poorly
A custom device may be considered where the defect is too large or irregular for a prefabricated button to fit comfortably.
Symptom Control Is the Main Goal
In some cases the practical objective is to reduce crusting, bleeding, whistling or airflow-related discomfort rather than to reconstruct the septum.
A Custom Button and Surgical Repair Are Different Treatments
| Consideration | Septal Button | Reconstructive Repair |
|---|---|---|
| Main aim | Cover the opening and reduce selected symptoms | Reconstruct tissue and attempt anatomical closure |
| Reversible | Usually yes — the device can be removed | No — surgery changes the tissue permanently |
| Healing demand | No surgical closure of the perforation | Requires postoperative tissue healing |
| Ongoing maintenance | Adjustment or replacement may be needed | Follow-up is required to assess healing and outcome |
| Suitability | Depends on fit, tolerance, anatomy and treatment goals | Depends on size, cause, tissue health, support, previous surgery and other factors |
What Should You Ask Before Choosing a Septal Button?
- Is the perforation stable, and is the underlying cause understood?
- Is a standard button likely to fit, or would a custom device be more appropriate?
- What symptoms is the button expected to improve?
- What problems could make the device uncomfortable or unsuitable?
- How would the button be reviewed, cleaned, adjusted or replaced?
- Would using a button affect the possibility of future reconstructive surgery?
Where CT-Guided Custom Septal Buttons Fit Into Modern Care
The published CT-guided technique demonstrated that custom fabrication can help address some of the fitting problems associated with large or irregular septal perforations. The study also reported improvement in several common symptoms.
However, a custom button should not be presented as a guaranteed or permanent solution. Tolerance varies, some patients require replacement or removal, and a prosthesis does not biologically close the septal defect. The most appropriate option depends on the cause of the perforation, symptoms, anatomy, tissue health, previous treatment and the patient’s goals.
Evidence Used in This Article
- Price DL, Sherris DA, Kern EB. Computed Tomography for Constructing Custom Nasal Septal Buttons. Archives of Otolaryngology–Head & Neck Surgery. 2003;129(11):1236–1239.
- Recent UK clinical audit: Outcomes of Silastic Septal Button Insertion for Nasal Septal Perforations: A Five-Year Retrospective Clinical Audit.
- General clinical background: Septal Perforation — StatPearls.