Nasal septal perforations present a distinct challenge to the facial plastic surgeon, and a problem to the patient. A clear-cut causal factor must be established from a long, diverse list of potential causes, some of which can be Iifethreatening. Surgical repair presents a complex technical challenge, because a septal perforation is a hole in three distinct contiguous layers composed of both right and left septal mucoperichondral flaps and the intervening cartilage, all three of which must be separated from each other and repaired individually. Many procedures to repair septal perforations have been described. Those techniques that have the best physiologic result, the highest success rate, and the best long-term patient acceptance and comfort require the use of bilateral intranasal mucosal advancement flaps with the interposition of a connective tissue graft. This article describes presenting symptoms and findings for septal perforations, the history and physical cxamination, causes, helpful hints for prevention or perforations, and surgical and nonsurgical treatment options and outcomes.
