Perforation of the nasal septum may have multiple causes: traumatic, iatrogenic, infectious, degenerative, overuse of vasoconstrictors, abuse of cocaine and more recently chemotherapy agents. Perforations are also classified according to their size and type of cartilaginous or osteocartilaginous deficit, as well as location (front, middle and rear). many surgical techniques have been proposed to repair the perfo-ration, although the results are often unsatisfactory for perforations of small and medium size; in large perforations permanent obliteration of the defect cannot always be ensured. it is often necessary to use tissues from inside the nasal turbinates or cartilage from other donor sites such as the ear or rib, and various techniques are discussed in light of the recent literature. The perforations observed in the last eight years and surgical approaches performed in open or closed approaches are taken into account. The authors propose a new technique that has been used with success in many types of septal perforation regardless of aetiology, and in particular large perforations, which allows for the use of the osteocartilaginous donor site as a hump. it is also useful in reductive rhinoseptoplasty, which targets selection to easily obtain mucopericondral flaps with an extramucosal technique and to obtain also an aesthetic improvement
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