Long term results of fashioned costal cartilage block as interpositional graft for large septal perforations closure

INTRODUCTION: Large nasal septal perforations (NSPs ≥2 cm) remain a significant surgical challenge with lower closure rates than smaller defects. Objectives & Hypotheses: We hypothesize that a fashioned costal cartilage neo-septal block used as an interpositional graft can achieve both anatomical and functional closure in large NSPs. STUDY DESIGN: Retrospective case series. METHODS: Twenty-six patients underwent NSP closure using a neo-septal block graft prepared by sagittal splitting of costal cartilage slices sutured into a watertight structure, covered with bilateral unipedicled rotational flaps. RESULTS: The mean perforation size was 27.5 × 16.4 mm, with a mean follow-up of 44.4 months. Anatomical closure was achieved in 22 patients (84.6%). In cases without complete closure, symptoms including crusting, bleeding, nasal obstruction, and whistling resolved. CONCLUSION: The neo-septal block graft is effective and reliable for large NSP repair , particularly when complete tension-free flap closure is not achievable, providing both anatomical and functional improvement.