Background: Nasal septal perforation is an anatomical defect of the cartilaginous and/or bony nasal septum. There are many causes for septal perforaton including prior nasal surgery ,nasal trauma , cocaine abuse ,inflammatory disorders ,infection , cancer. The mechanical closure with a prosthesis such as the septal button. Silicon buttons can alleviate epistaxis, whistling and nasal obstruction, but these prostheses cannot control the production of crusting around the margins of the button which causes discomfort for patients. Objectives: the aim of this study was to evaluate endonasal endoscopic repair of cartilaginous nasal septal perforation. Patients and Methods: The study included 24 Patients; they were 16 males and 8 females, their age ranged from 18 to 53 years to 50 years underwent endoscopic repair for the perforation of cartilaginous septum with alloderm and rotational flap. Results: The study, showed that 23 cases had complete healing after endoscopy with success rate (95.8%) and one case failed due to flap necrosis (4.2%). Conclusions: Endoscopic repair for the perforation of cartilaginous septum with alloderm and rotational flap approach can be considered as an effective technique for septal perforation. The use of Alloderm, has the advantage of decreasing morbidity and suitable for all perforations sizes, acting as an excellent scaffold for re-epithelization, but is associated with high costs and the septal flap provide a good vascularity for good healing .