Septal button: the prosthesis that plugs the hole

The button passes through the perforation and rests against each side of the septum.

First described by : Beekhuis and Eisenstein, Laryngoscope, 1977, for the first silicone model. Custom 3D-printed versions date from the 2010s.

A septal button does not close the perforation: it plugs it. Two soft silicone flanges, joined by an eyelet that passes through the hole, sit against each side of the septum. Airflow becomes laminar again, whistling usually stops, crusting decreases, but the perforation is still there, under the prosthesis, and silicone remains a foreign body the mucosa has to tolerate.

1. 1Endoscopic measurement of the perforation (height, width, distance from the front edge); for a custom model, a CT scan is used to build the 3D-printed file.
2. 2Choosing a size from a standard range, or having an individual prosthesis made (one piece, or two magnetic halves that meet inside the hole).
3. 3Fitting under local anaesthetic, usually in clinic: the flange is folded, introduced, then unfolded on the far side.
4. 4Review at two or three weeks, then regular checks: daily rinses are compulsory, the prosthesis has to be cleaned, repositioned or replaced if it migrates.
5. 5Removal is possible at any time, with no consequence for later surgery.

Named variants

• Patients who cannot have surgery (comorbidities, anaesthetic risk) or who do not want it.
• Mucosa still inflamed: active vasculitis, ongoing cocaine use, compromised healing.
• Very large perforations judged unclosable, instead of or while waiting for major surgery.
• A real-life test: if the button abolishes whistling and crusting, closure will probably bring the same benefit.
• A holding measure before an appointment in an expert centre, sometimes months away.

• First-line in an operable patient: the 2026 international consensus advises against offering a button before discussing closure.
• Incomplete rim: without a ring of tissue all around the hole, the prosthesis has nothing to sit on and migrates.
• A history of repeated nasal infections: silicone sustains them.
• Patients who will not do daily rinses: an unmaintained button smells and becomes infected.
• Anyone hoping for healing: nothing heals under a button, and rubbing can enlarge the perforation.

Published results

• Permanent foreign body: crusting on the prosthesis, bad smell, bacterial colonisation.
• Local infection 7.8%, granulations 5.2%, migration 2.6% in the 77-patient audit.
• Definitive removal needed in 15.6% (discomfort, infection, extrusion), replacement in 26%.
• Progressive enlargement of the perforation as the flanges rub against its edges.
• Satisfaction figures are largely self-reported: 81.8% say their quality of life improved, yet half of wearers no longer have it a few years later.

1. 1Standard model, or a custom prosthesis 3D-printed from my scan?
2. 2Who cleans it, how often, and what do I have to do every day?
3. 3What do I do if it smells, hurts or bleeds, who do I contact, and how fast?
4. 4Does wearing a button for two years compromise surgical closure later?
5. 5In your practice, how many patients still wear theirs after two years?

Write the answers down: they are what lets you compare two opinions.

Where it is done

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