Considerations in the etiology, treatment, and repair of septal perforations.

Nasal septal perforations present a distinct challenge to the facial plastic surgeon. A clearcut causal factor must be established from a long, diverse list of potential causes. 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. This article describes presenting symptoms and findings for septal perforations, the history and physical examination, causes, helpful hints for prevention of perforations, and surgical and nonsurgical treatment options and outcomes.