Severe septal injuries associated with nasal deformities are a challenge both functionally and esthetically. Serious septal injuries may include comminuted caudal border fractures, septal crushes, and saddling with loss of septal height. These may result from trauma or previous ill-considered surgery. A series of 60 cases involving radical removal of the septum with caudal and dorsal border reconstructions is reviewed. An external approach septorhinoplasty was utilized in the majority of these patients. The anterior septum was usually replaced by straight posterior septum or septal fragments. In a number of cases the septum was replaced by a centre cut of rib cartilage. Upon occasion the upper laternal cartilages were replaced by composite conchal grafts with or without septal replacement. An attempt has been made to evaluate critically the results with a longterm follow-up over a number of years, as regards both functional and esthetic results.