H.Sh. Davudov, G.B. Elkun, K.V. Akopyan, I.I. Nazhmudinov, B.G. Konstantinov, I.O. Kulikov, Federal State Institution Scientific Center of Otolaryngology, Russian Health Ministry, Moscow. The problem of trauma, and especially traumatic brain injury, not only remains relevant in all industrialized countries but has also become a social problem. In this regard, it should be noted that injuries to the nose, paranasal sinuses, and adjacent areas are only a particular type of traumatic brain injury and are of great importance in the clinical presentation, diagnosis, and treatment of patients with related injuries. The aim of this study was to study the true structure of trauma to the nose and other facial skeletal structures, and to determine the frequency, prevalence, and characteristics of their combined interactions. We examined 3,080 patients with acute traumatic brain injury (TBI), among whom 591 (19.2%) had injuries to the external nose, paranasal sinuses, and adjacent areas. Men constituted 67% of the patients, and women 39.2%, aged 16 to 75 years. When studying the causes of injury, it was found that 74.9% of patients had domestic injuries, 49.2% had industrial injuries, 12.1% had street injuries (including traffic accidents), and 3.8% had sports injuries. Among patients with injuries to the nose, paranasal sinuses, and adjacent areas, 342 (58%) had concussions. Brain contusion of varying severity was found in 248 patients (42%), including intracranial hematomas in 91 (5.3%) and skull vault and base fractures in 51 (8.7%). Radiography and, in many cases, computed tomography were of particular importance in the examination of patients with nasal trauma, as they made it possible to clarify the extent of the damage. They helped to identify the characteristics of the trauma to the anterior and posterior walls of the frontal maxillary sinuses, the extension of fractures to the lower walls of the frontal sinuses and other structures of the anterior cranial fossa. They also made it possible to determine the nature of the displacement of bone fragments. Isolated injuries to the external nose were diagnosed in 361 (61.1%) patients. Fractures of both nasal bones with a depressed nasal bridge or fractures localized closer to the free edge of the bone were observed in 157 victims. Lateral displacement of bone fragments was observed in 204 cases. Most patients with external nasal bone displacement had deformity of the nasal septum. Maxillary sinus injuries were the most common and were observed in 83 (14%) patients. The second most common facial skeletal injury in patients with TBI was frontal sinus fractures, which were observed in 57 (9.6%) victims. Ethmoidal labyrinth fractures were diagnosed in 33 (5.5%) patients. It should be noted that the ethmoidal labyrinth cells are most often affected with the maxillary or frontal sinuses, which play a dominant role in the injury picture. Isolated ethmoidal labyrinth injuries were noted in 8 (1.3%) patients, zygomatic bone fractures in 35 (6%), and orbital fractures in 15 (2.5%) patients. Damage to the nose and other facial skeletal structures during acute traumatic brain injury interact with one another, aggravating the course of traumatic injury, complicating the determination of injury severity, complicating diagnosis, and introducing new features into the clinical picture of the initial period of traumatic brain injury. Treatment measures were tailored to the nature of the facial skeletal damage and the severity of traumatic brain injury. Bleeding from the nose and paranasal sinuses was immediately stopped, and a tracheotomy was performed, in parallel with resuscitation and neurosurgical measures. At the same time, treatment measures related to the elimination of cosmetic defects of the face were delayed for two to three weeks or more, depending on the severity of the patient's condition. This wait-and-see approach, in our opinion, allows for dynamic observation of patients, as traumatic brain injury requires particular neurosurgical vigilance. Thus, the compensated phase of compression by an intracranial hematoma can manifest as a concussion. Furthermore, a wait-and-see approach to the subsequent stage of surgical treatment allows for avoiding additional stimulating effects on a critically ill patient in the early stages of acute traumatic brain injury. In conclusion, it should be noted that in cases of nasal injury and other facial skeletal structures associated with traumatic brain injury, the best treatment outcomes can be achieved when the otolaryngologist and neurosurgeon strictly adhere to a consistent approach.