G.Z. Piskunov, O.V. Parakhina, Otolaryngology Course, URC MC, UD RF Presidential Administration, Moscow. Otolaryngologists frequently encounter situations in which a nasal malformation is combined with a deviated septum, hypertrophy of the nasal turbinates, and inflammation of the paranasal sinuses. This is a complex group of patients, and we currently lack a consensus on the surgical sequence for restoring respiratory and aesthetic function of the nose and treating paranasal sinus disease, which often depends on the existing deformities of the nasal structures. The objective of the study was to improve the provision of medical care to this category of patients. We reviewed 102 case histories (51 men and 51 women) treated from 1997 to 2002 and who underwent combined surgeries. All patients had various types of external nasal deformities combined with a deviated septum and hypertrophy of the nasal turbinates. In most cases, the external nasal deformity was associated with trauma. In 14 patients with severe scoliosis, there was no history of trauma, and a sharply deviated septum "pulled" the nose to the side. Fifteen patients had a perforation of the nasal septum. Inflammation of the paranasal sinuses (polypous polysinusitis) was diagnosed in 17 patients. In one case, odontogenic sinusitis and an oroantral fistula were detected. All patients underwent the full necessary scope of surgical intervention under general anesthesia: open rhinoseptoplasty in 26 cases, closed rhinoseptoplasty in 76 cases, closure of the nasal septum perforation in 15 cases, endoscopic polysinusotomy in 17 cases. One patient underwent endoscopic revision of the maxillary sinus and closure of the oroantral fistula, and all patients underwent correction of the nasal turbinates. Patients received antibiotic therapy, which in some cases began the day before surgery and continued for 4-6 days. Nasal breathing was restored in all patients. Three patients underwent revision rhinoplasty due to deformation of the displaced cartilage grafts. In two patients, the perforation did not close, although its size decreased. Twelve patients had nasal septal hematomas. No recurrence of polyposis was observed in the patients who underwent surgery. We distinguish two categories of surgeries: those performed for pathology not associated with an inflammatory process and those performed in conditions of chronic inflammation in the paranasal sinuses. In surgeries of the first category, septum correction is performed first, then correction of the external nose, and the surgery concludes with correction of the turbinates. If correction of the nasal tip and the cartilaginous portion of the external nose is necessary, preference should be given to open rhinoseptoplasty. When correcting only bone structures, closed rhinoseptoplasty is advisable. When deformities are combined with inflammation of the paranasal sinuses, we first perform septoplasty, which facilitates access to the middle nasal meatus. Then, intranasal endoscopic sinus surgery is performed, followed by open or closed rhinoplasty. The surgery concludes with correction of the turbinates. In all cases, turbinate surgery is performed last, as it is associated with bleeding and requires packing. Conclusions: 1. When restoring the aesthetic and respiratory functions of the nose, surgical intervention should be performed simultaneously, rather than separated into several stages. 2. The choice of surgical approach is individualized, but the stage that facilitates the subsequent stage is the most important. 3. For correction of cartilaginous structures of the nose, preference should be given to open rhinoseptoplasty. When correcting bone structures, it is better to use various osteotomy options with closed rhinoseptoplasty. 4. Restoration of the aesthetic and respiratory functions of the nose has a positive effect on the course of the inflammatory process, the treatment of which must be continued with medication.