Most nasal septal perforations fortunately do not cause any symptoms, therefore do not require any treatment. But in cases of much crusting and severe nasal bleeding, closure of peforation should be considered. The aim of the management of septal peforation is to stop the causative disease process and encourage natural healing process of the lesion. But if these do not occur, physician should consider a surgical repair. The perforation can be closed by direct closure, rotation pedicle flap, composite graft and temporalis fascia inlay graft. Recently we experienced two cases of large septal perforation about 2.0×2.0cm, 2.0×1.8cm in diameter with unknown etiology which were closed by temporalis fascia and auricle cartilage graft by the external rhinoplasty approach with good postoperative results. So, we reported these cases with review of the literatures.