A.G. Volkov, N.A. Zakharova Rostov State Medical University As frontal sinus osteomas grow, the structures of the frontonasal canal are often destroyed, necessitating the formation of a frontonasal junction. To reduce the incidence of recurrence after frontal sinus surgery, combined tubular drains have been introduced. These drains consist of a rigid tubular drain for fixation and tissue material (skin, multilayered heterogeneous formalinized bovine peritoneum, umbilical cord, etc.). All types of these drainage tubes were maintained in the junction for 7-8 days to 4 years postoperatively. A.N. Pomukhina and A.G. Volkov (1982) used a femoral artery fixed to a Teflon drainage tube to form a frontonasal junction. The ostium was formed over a period of 28-35 days, after which the Teflon tube was removed. The artery, for the first time in postoperative interventions, was not removed and became part of the ostium. We used this method of creating a frontonasal ostium after opening the frontal sinuses as a basis for its creation in patients with significant destruction of the frontonasal canal. In 6 patients, after removal of large osteomas of the frontal sinuses (or frontoethmoidal region) with significant destruction of the frontonasal canal, combined drainage tubes were used. Their rigid core consisted of Portex thermoplastic tubes, which we shaped into an "hourglass" shape. This shape was represented by upper and lower sockets and a narrow central "belt" section. A femoral artery fragment of the same shape, fixed to a tube, was used as the tissue component. Two to three hours before surgery, the lyophilized artery fragment was soaked in warm saline solution containing an antibiotic. After removing the osteoma and preparing the frontonasal junction, an artery fragment with a diameter equal to that of the tube was fixed to a thermoplastic drainage tube. The artery was slightly stretched due to the elasticity of its wall, and its length was 1-2 mm shorter than the tube. Notches were made on the lower end of the combined drainage tube on the artery and tube walls, forming "lower petals." Then, using a special device, the combined drainage tube was inserted through the nasal cavity into the formed frontonasal junction, positioned in the frontal sinus and nasal cavity, and the "lower petals" of the artery, which were fixed by the "petals" of the tube, were straightened. The next step involved making similar incisions on the upper socket of the tissue portion of the drainage tube. These manipulations were performed without damaging the tubular drainage, and the resulting "upper petals" of the artery and the tube securing them were straightened and positioned, along with a special fragment of fibrin film. Before grafting the bony walls, the sinus lumen was thoroughly dried. This position of the combined drainage tube ensured its stability within the ostium and favorable conditions for the outflow of wound fluid from the sinus. Removal of the rigid portion of the drainage tube was performed no less than 3 months after the procedure. The postoperative period was uneventful in 5 patients; mucohemorrhagic wound discharge from the sinuses persisted for 8-12 days. In one patient, mucopurulent discharge appeared from the nasal cavity on the 5th day after the procedure. A swab was taken for bacteriological examination, and targeted antibiotics were prescribed. Over the following days, the operated frontal sinus was irrigated with targeted antiseptic and antibiotic solutions through a catheter (fixed to the "belt" of the combined drainage system and introduced into the sinus lumen). Sinus irrigants were discontinued after exudation ceased. All of our patients continued surgery until the rigid portion of the drainage tube was removed. Once the frontonasal junction was formed, the rigid portion of the combined drainage system was easily removed by traction on the catheter, and the vascular fragment became part of the frontonasal junction wall. There were no recurrences or purulent complications in the operated group of patients during follow-up periods ranging from 4 months to 1.5 years.