ABSTRACT
According to the experience of the main author extending over more than 20 years (more than 100 cases) in the treatm,ent of septal perforations, we have the deep conviction that all techniques using local flaps should actually be considered to be obsolete, as the blood supply is insufficient. Perforations with diameter up to 4cm can be closed in a one stage procedure with extensive disection of the mucoperichondrium and mucoperiosteum of the septum, the vault and the vestibular and cavity floor. The hole in the quadrangular plate can be reduced by a push back or push down manoeuver of part of the cartilage. For closure of perforations larger than 4 cm in diameter, we use a 2-3 stage procedure using a composite bucal flap with three layers (mucosa0cartilage and mucosa) and a gingivolabial pedicle. Thus all kinds and size of perfrations can be closed surgically avoiding the use of silicone obturatirs which only enlarge the hole