ackground: Rhinologists frequently encounter challenging cases of septal perforation, and to date, no definitive consensus exists regarding the most appropriate surgical technique. Methods: The study included adult patients with anterior septal perforation. All patients underwent a general and ear-nose-throat examination (including upper airway endoscopy) as well as computed tomography of the nose and paranasal sinuses. The endoscopic unilateral anteriorly-based nasal flap procedure was performed under general anesthesia. Results: Fourteen patients with anterior septal perforations measuring 11–25 mm in diameter were included. The procedure was performed smoothly without intraoperative complications, with operative times ranging from 40 to 70 minutes. The follow-up period ranged from 6 to 14 months. Postoperative pain was minimal and well tolerated. Nasal crusting was mild and resolved almost completely within 2 weeks. By the end of the first postoperative month, no patient reported nasal obstruction. Complete resolution of preoperative symptoms occurred in 12 of 14 patients (85.7%), while the remaining two patients (14.3%) experienced symptomatic improvement. Conclusion: The anteriorly-based nasal floor mucoperiosteal flap yields favorable outcomes in patients with septal perforation, with minimal morbidity