Approach to Surgical Repair of Nasal Septal Perforation.

Nasal septal perforation repair remains technically demanding, with technique selection guided by perforation size, location, etiology, and patient risk factors. Contemporary evidence supports mucosal advancement flaps for small perforations (< 1 cm), bilateral advancement with interposition grafting or trilayer temporoparietal fascia-polydioxanone constructs for medium perforations (1-2 cm), and pedicled flaps for large (≥ 2 cm) or revision cases, with overall closure rates ranging from 84% to 98%. Modifiable risk factors, including active smoking, uncontrolled diabetes, and ongoing intranasal drug use, should be optimized preoperatively, as they are independently associated with significantly increased failure rates.