Nasal septal perforations present a distinct challenge to the otolaryngologist-head and neck surgeon, and a problem to the patient. A clearcut etiology must be established from a long, diverse list of potential causes, some of which can be life-threatening. 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 have been described to repair septal perforations. 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. The presenting symptoms and findings, the history and physical examination, the causes for septal perforations, helpful hints for prevention of perforations, and surgical and nonsurgical treatment options and outcomes will be described in detail.
