Purpose of Silicone Buttons in the Nasal Septum
Silicone buttons in the nasal septum are primarily used to treat symptomatic nasal septal perforations by mechanically obturating the perforation when surgical repair is not feasible or desired. 1
Clinical Indications
- Silicone buttons serve as a non-surgical alternative for managing symptomatic nasal septal perforations when repair is not possible or desired 1, 2
- They are particularly useful for patients with perforations resulting from:
Symptom Relief
Silicone buttons effectively reduce multiple symptoms associated with septal perforations:
- Significantly decrease nasal crusting around perforation margins 4, 5
- Eliminate whistling sounds during nasal breathing 2, 5
- Reduce or eliminate epistaxis (nosebleeds) 2, 5
- Improve nasal obstruction and airflow 2, 5
- Decrease pain and discomfort 3
- Reduce the feeling of dryness in the nasal cavity 2
Types of Silicone Buttons
- Custom-made silicone buttons created from impression molds of the patient's nasal septum 5
- Pre-fabricated one-piece or two-piece silicone buttons (such as Xomed) 4
- The newer buttons offer greater plasticity and adaptability, providing better conformity to the septum 4
Advantages Over Surgical Repair
- Office-based procedure that can be performed without general anesthesia 2
- Can be inserted by physicians or by patients themselves after proper training 2
- Avoids the morbidity associated with surgical procedures 6
- Effective for perforations of various sizes (documented from 7.4 to 807 mm²) 3
- Long-term solution with buttons remaining functional for years (follow-up periods of 1-9 years reported) 2
Contraindications
- Acute infection with osteitis 4
- Active chronic septal disease (such as active Wegener's granulomatosis) 4
- Neoplasia 4
- Extremely large perforations that cannot be adequately covered 4
Patient Satisfaction and Outcomes
- High patient satisfaction rates with significant symptom improvement 5
- Long-term septal button users report median improvement of 91% on visual analog scales 5
- Majority of patients (69% in one study) continue using the button at long-term follow-up 5
- No cases of infection have been reported in connection with silicone prosthesis use 2
Clinical Pearls
- The size and location of the perforation do not appear to be predictors of treatment success 5
- Regular follow-up is recommended to ensure proper fit and function of the button 2
- Patients should be educated on proper care and cleaning of the silicone button to prevent complications 2
- For patients with recurrent septal perforations after failed surgical repair, silicone buttons provide a reliable alternative management option 3, 6