This chapter discusses surgery of the nasal septum, where an increased understanding of the functional role of the nasal septum has better defined the disease states that result from septal deformity, and has allowed for the development of various techniques that aim to re-establish normal function. Traumatic displacement of the quadrangular cartilage off of its midline perch on the maxillary crest can result in cartilaginous and bony septal spurs along the floor of the nose. Medical comorbidities that may be contraindications to septoplasty should be identified, including Wegener’s granulomatosis, intranasal cocaine use, bleeding diathesis, extensive prior nasal surgery, or large septal perforation. The most common indication for septoplasty is nasal obstruction, which is the most common presenting complaint in a rhinologic practice. Caudal septal deflections are typically accessed via a transfixion incision. The primary goal of surgical perforation repair is to restore the normal function of the nose.