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.