OBJECTIVE: The aim of this study is to identify the possible causes of septal perforation in patients seen in the department of Otorhinolaryngology of Blumenau/SC. CASE REPORT: We analyzed medical records of 57 patients with an established diagnosis of perforation of the nasal septum, observed from January 2007 to July 2012. The etiology of these perforations was then classified and quantified. After quantification, we performed a literature review. The results were consistent with what is commonly reported in the literature. Iatrogenic causes were the most important causes of perforation (42.11%), with septal surgery being the most common cause. After these causes, infectious appears with 17.54%, and leishmaniasis as the main cause. Septal perforations (12.28%) were idiopathic. CONCLUSION: Few studies have investigated nasal septum perforation as a complication. These will be needed to address the septal perforation as a statistic, and not as just as a possible outcome. Septal surgery and granulomatous diseases - the professional must be aware of the symptoms of complication to initiate appropriate treatment.