ENT surgeon will fill a hole in septum with a plastic "button".

Question

Is this an established and proven method? To fit the button, some of the deviated septum needs be removed, and also turbinates will be reduced. The large hole was produced by a rhinoplasty years ago. Breathing is not affected, but severe nosebleeds (posterior, both sides) began 6 months ago, due to dry nose resulting from hole in septum.

Jacob Sedgh, MD · Answer

Surgical treatment of a septal perforation remains to be one of the most challenging of nasal surgeries. Failure rates of up to 50% traditionally have been reported. Thus it is wise to consider conservative measures before relying on surgery. That includes topical care to keep the nose moist and lubricated to prevent nosebleeds and/or use of a septal button. However many patients do not tolerate the button well. If above measures all considered and the patient is still symptomatic he or she should seek surgical treatment by a surgeon who has major experience and success record with treatment of septal perforations.

William Marshall Guy, MD · Answer

Hello Two Shoe,There are several ways to treat septal perforations.  Depending on the size and reason for the perforation, surgery can be used to correct the hole.  This can carry a high risk of recurrence of the perforation.  Therefore, you can also treat the symptoms.  First treatment involves keeping the area moist and sometimes some topical lubricants.  If these fail to control the bleeding (which is caused by turbulent airflow hitting the perforation), then the use of a silastic button placed into the perforation can help.  It works by covering the raw edges allowing the area to heal and stop bleeding.  It won't correct the perforation but will correct the symptoms. I hope this helps and good luck.

Fred J. Bressler, MD, FACS · Answer

I am sorry to hear that you suffer with a large nasal septal perforation after previous rhinoplasty. How large is it? If you are considering more surgery for a deviated nasal septum and enlarged turbinates, there maybe an opportunity for you to undergo surgical repair of the nasal septal perforation with acellular tissue grafts placed via open rhinoplasty approach, combined with bilateral mucosal advancement flaps. This is complex and sometimes difficult surgery. The success of complete surgical closure depends on location, size, mucosal appearance, and other factors. Very large perforations, 3 cm or larger, are extremely difficult to close. Local care with regular debridement and irrigations can often help, so these patients often choose not to have surgery.  Smaller perforations, 1cm or less, have highest success rate. Intermediate perforations, 1-3cm, may be candidates for successful correction, but sometimes the plastic buttons are tried to see if symptoms of bleeding, pain, dryness and crusting can be helped non-surgically. Personally, I am not fan of plastic buttons and would prefer actual surgical correction for appropriate cases, as buttons have issues with irritating the nose, infection, enlargement of the perforation and bleeding too often. Nevertheless, if you tolerate the placement of the button and are comfortable with the longterm care and maintenance, it is an acceptable alternative to surgery. Hope this information is helpful. Best Regards.

ENT surgeon will fill a hole in septum with a plastic "button".

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ENT surgeon will fill a hole in septum with a plastic "button".

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Everything you need to know about Revision Rhinoplasty

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