Computed Tomography for Constructing Custom Nasal Septal Buttons

Objective: To determine the efficacy of computed tomography in creating custom nasal septal buttons. Design: Retrospective chart review and telephone follow-up. Setting: Tertiary care referral center. Subjects: Ninety-five patients with symptomatic septal perforations repaired with custom Silastic septal buttons fashioned from reformatted computed tomographic images. Follow-up greater than 1 month was obtained in 74 patients (range, 1 month to 17 years; mean, 44.6 months). Interventions: Custom septal buttons were placed intranasally under local or general anesthesia. Main Outcome Measures: Patients were evaluated for resolution of preoperative symptoms related to the septal perforation, new symptoms related to the button, and duration of button retention. Results: The average perforation was 2.6 cm in diameter (range, 6 mm to 6.0 cm). Nine buttons (12%) came out unexpectedly. Nine buttons were removed because of patient intolerance, and 14 buttons were lost or removed after 5 years, longer than the projected button life span. Excluding buttons that were removed because of patient intolerance, 56 (86%) of 65 buttons were in place for longer than 5 years or at the most recent follow-up. Most patients experienced improved breathing (60%) and a considerable reduction in epistaxis (77%) and nasal crusting (59%). Conclusion: Custom septal buttons created using computed tomography are effective in relieving symptoms from large septal perforations.