REVIEWState-of-the-art: septal perforation repairGaraycochea, Octavioa,b; Santamaría-Gadea, Alfonsoc; Alobid, Isama,d Author Information aRhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University. Barcelona bDepartment of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona cRhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal dUnidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain Correspondence to Isam Alobid, Rhinology Skull Base Unit, ENT Department, Hospital Clinic, Barcelona University, Barcelona, 08036, Spain. Tel: +34932275541; e-mail: [email protected] Current Opinion in Otolaryngology & Head and Neck Surgery ():10.1097/MOO.0000000000000857, December 07, 2022. | DOI: 10.1097/MOO.0000000000000857 Buy PAP Metrics Abstract Purpose of review To provide a comprehensive overview of the evolution of the different techniques described for the surgical repair of nasal septal perforation, and a surgical decision-making algorithm for its surgical treatment. Recent findings Septal perforation surgery has evolved and improved in recent years. It has gone from being an avoided or discouraged surgical procedure to a procedure with success rates of >90%. Nowadays, there is no standard approach or single technique. The different techniques described include unilateral random pattern flaps, interposition grafts, unilateral pedicle septal local flaps, free mucosal grafts and bilateral random patter flaps. The incidence of success is higher in pediculated septal flaps such as the anterior ethmoidal artery flap or the greater palatine artery pedicled flap combined with additional techniques. Summary Nowadays, surgical closure of septal perforation is possible and should be an option to consider in symptomatic patients without response to medical treatment. The surgical approach that we recommend when planning the surgical closure of nasal septum (or nasoseptal) perforation is based on the osseocartilaginous support and the location of the defect. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.