Nasal septal perforation is often troublesome for the patient. It is manifested by crust formation, epistaxis, impaired nasal ventilation, headache, a whistling sound during breathing, leakage of mucus into the nasopharynx, rhinorrhea, hyposmia, snoring, vocal changes, recurrent upper airways infections, odour in nose. Previous laminar air ventilation changes into turbulent. The streaming air dries the perforation margins, crusts are formed that after removal cause bleeding and the perforation enlarges progressively. In these patients complex therapy is indicated. Every nasal septal perforation that enlarges progressively and causes the mentioned problems is indicated for surgical or conservative treatment. In the literature there are many methods of various mucosal and cutaneous flaps used for covering the perforation, insertion of silastic buttons or only regular intarnasal toilette and moisture of the nasal mucosa by ointment. From 1989 30 patients were operated on for a perforation of the nasal septum of various origin. Three methods of covering perforations are presented. The operative challenge depended on the size of the perforation, quality of nasal mucosa, position of nasal septum and nasal airways passage. The first described method was used in 20 patients, the second in 3 and the third in 7 patients. In covering a small perforation we used for a long time the method of local mucoperichondrial and mucoperiosteal flaps with insertion of an aural cartilagineous graft into the original defect. Long-lasting (more than one year) results were not favourable. The perforation was closed in one half of the patients, in some patients the defect diminished, nasal ventilation improved also in connection with a corrected nasal septal deformity and treated allergic rhinitis. In three cases with a large perforation (2 - 3 cm) the method of a buccal and vestibular mucosal flap with insertion of cartilage or bone between them was used. This method failed in all cases because of flap necrosis. The perforation gradually reached the original size. One patient with a bony implant had the perforation covered for six months. This lead us to seek a more effective and safer method. We developed a method of inverted flaps that are drawn through the perforation on the opposite side. In the literature we did not find a report on such a technique. The method of bilateral inverted flaps has certain advantages. 1. After the flap is turned into the perforation it is automatically covers the posterior and inferior margin of the perforation because flaps cover it by their pedicle. Stiches have to be situated at the superior margin and just behind the columella. These places are usually accessible and insertion of the suture does not cause a problem. 2. Flaps are quite thick after suture, they have a good blood supply and when covering smaller perforations there is no need to insert a cartilage between them. 3. Behind the perforation and on the base of the nasal cavity there is enough material for covering a perforation even greater than 1.5 cm diameter. The method of inverted flaps is suitable in all perforations where cartilage or bone around the defect is preserved. Patients after resection of septal cartilage and after partial removal of septal bone are not acceptable candidates for this method. Their septum is created by two layers of mucoperichon- drium grown together. If there is a perforation in soft bleeding tissue with atrophy, it is not possible to create on adequate mucoperichondrial flap, because such tissue is resistent to surgical prepara- tion. Another method has to be chosen in that case.

        Key words: nasal septal perforation, surgery of a perforation, local transposition flaps, flaps from buccal mucosa, inverted flaps, midfacial degloving.