Definition & Overview
A nasal septal prosthesis, also called a nasal septal button, is a device used to close a perforation (hole) in the nasal septum; a condition referred to as a nasal septal perforation (NSP). The prosthesis can be made out of acrylic, plastic, or silicone.
The nasal septum is the cartilage that separates the left and right nostrils. A hole in the septum may, or may not, produce a variety of symptoms. NSPs that do not produce any symptoms usually don’t require any treatment.
NSPs that produce symptoms can be treated conservatively, which involves the use of humidifiers or skin moisturisers to reduce the symptoms. However, if the method fails, the surgical closure of the perforation could be required.
Unfortunately, closing the hole in the septum through surgical means is a complicated task. In fact, there are only a few surgeons who specialise in this particular procedure. There is also a possibility that the surgery may not be a success. A viable alternative to surgery is to insert a nasal septal prosthesis in the hole to close it.
An insertion of a nasal septal prosthesis is much less complicated. The procedure can be done in a doctor’s office. However, like any other medical procedure, inserting a septal prosthesis has associated risks and can result in complications.
Who Should Undergo & Expected Results
As mentioned earlier, the candidates for an insertion of a nasal septal prosthesis are patients with a perforation in the nasal septum that results in one or more symptoms. The most common symptoms of an NSP include:
- Breathing difficulty
- Excessive mucus production resulting in a runny nose
- A whistling sound while breathing through the nose
- Dryness of the nasal septum resulting in crusting
If the insertion of the prosthesis is successful, patients can expect a significant reduction of the symptoms. Unfortunately, not all procedures can be deemed a success. If the procedure fails, the ENT doctor may need to replace the prosthesis or recommend a surgical closure of the perforation instead.
How Does the Procedure Work?
Several techniques can be used to perform this procedure. The particular technique an ENT doctor may opt to use will depend on his or her expertise in that technique, the type of prosthesis to be used, and the condition of the perforation.
There are several different types of nasal septal prostheses. The traditional types are one or two-piece devices. The prosthesis is made up of two circular shaped flanges connected by a tube in the centre. The concept of the procedure is to insert the prosthesis in the septal perforation. The flanges will then close the hole. If successful, the symptoms of the condition should be reduced almost immediately. Prior to the procedure, the doctor will first clean the nasal cavity to remove mucus or any obstructions, such as crusting. The doctor will then apply a local anaesthetic so the patient will not feel any pain throughout the procedure.
Using a paper, special marking pen, and ruler, the doctor will measure the perforation so that the right size prosthesis can be used. Using the wrong size can result in the failure of the procedure. Once the right prosthesis has been selected, the doctor will roll the flanges into a tube shape and insert the device into the narrower nostril. One flange is inserted into the hole so that it can be moved into the wider nostril.
The doctor will then carefully pull the rest of the flange through the hole and move the device a bit so it fits snuggly and effectively covers the hole.
After the procedure, the patient will be instructed to clean the nasal cavity at least three times a day using saline solution. Once the area is cleaned thoroughly, nasal cream will be applied to prevent it from drying up and causing problems. The patient may also be instructed to perform steam inhalation for about two weeks.
The patient will need to use the prosthesis for as long as the perforation in the septum is present. This could mean a lifetime. However, there might come a time wherein the prosthesis will need to be replaced. This time will depend on the patient’s willingness and dedication in cleaning the nasal cavity. Some patients don’t require a replacement until well over a year the prosthesis has been in place.
Possible Risks and Complications
Patients should be aware of the possibility that the nasal prosthesis may not fit or adjust to the nasal cavity properly. If this happens, the device may not only feel uncomfortable, but may also result in excessive tearing in the eyes and/or a runny nose. In some cases, the device may cause the patient to sneeze repeatedly.
If the prosthesis is made of soft silicone, there is also the possibility that the tip of the flanges may bend while breathing forcefully. This could result in the tip blocking the nasal cavity making it difficult to breathe from time to time.
A failed nasal septal prosthesis insertion means that the device needs to be replaced. The doctor may need to select a different size or a device that can be customised to the patient’s needs. Surgery to close the perforation can also be recommended.
References: * M Mullace, E Gorini, M Sbrocca, L Artesi, N Mevio; “Management of nasal septal perforation using nasal septal button”; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639999/
Belachew Tessema; “Nasal Septal Button Placement”; http://emedicine.medscape.com/article/1580556-overview?pa=tzROFhc1hcJcCjaijWRaEFPawVn8Ojp1qcxOOGAu9dTlJSY5GQygMK3qiTI%2Fl7AtihS5yMijIYstO%2BztpGLUGCchrzF%2F7vlnSF6AEX%2F09M8%3D#a7
Thomas Romo III MD, FACS; “Septal Perforation – Surgical Aspects Treatment & Management”; http://emedicine.medscape.com/article/878817-treatment#d11