<p>Nasal septal perforation (NSP) is a symptomatic septal defect with diverse etiologies, including iatrogenic injury, trauma, inflammatory disease, infection, and substance use. Surgical management remains challenging, with approaches ranging from endonasal mucosal advancement flaps to endoscopic and open techniques. This PRISMA-guided systematic review examined contemporary NSP repair methods to identify predictors of success and failure. A systematic search was conducted from database inception to December 2025, with eligibility restricted to studies published from January 2023 onward. Screening was performed in Rayyan, with full-text data extracted by four reviewers and checked for duplication. Risk of bias was assessed using the ROBINS-I tool.</p>