The first part of this article published in Orthodontie Bioprogressive (vol. 19, n° 2, December 2011) presented the clinical and paraclinical modalities of the positive diagnosis of nasal obstruction in adults and children. It detailed the various etiologies, in particular architectural, mucosal, and tumor-related causes that could explain such symptomatology.
This second part addresses the different physical and surgical treatments currently available and their respective indications / see the document below.

Intermaxillary disjunction with endo-osseous anchorage on minivis by O. RICHARD, M.C. NICAUD-LÉON, F. FACON
Managing the transverse dimension of the maxilla in adults requires orthodontic-surgical collaboration, in order to perform a surgical intermaxillary disjunction in cases of maxillary endognathia. Unlike in children, tooth loss, prosthetic rehabilitation, or periodontal recessions do not always allow the use of a tooth-borne disjunctor.
We will present how to create a customized disjunctor that is anchored directly to the maxillary bone through minivis. This process makes it possible to obtain a more horizontal distraction vector and to reduce the effects of tipping and dental vestibulo-versions,
as well as the excessive forces that may be observed with “classic” tooth-borne disjunctors.
We will illustrate this presentation with a clinical case, showing the surgical management and the design of this disjunctor.

Minimally invasive procedure for mandibular osteotomy / C. PAULUS, W. KATER, J.-L. OUHIOUN
Mandibular osteotomies for orthognathic purposes are an integral part of our treatment plans. The frequency of these procedures must
help us move forward toward greater accuracy, more comfort, and less
morbidity.
Modern mandibular osteotomy techniques make it possible to improve the quality and safety of facial osteotomies. Among these advances, we describe the short high sagittal osteotomy (HSSO), which
helps reduce postoperative discomfort, diminish oedema, and above all
protect the alveolar nerve.

Functional education and posture / J. BOHAR
In my opinion, there are two types of orthodontics that have been developing for some time. One, which I would call « alignodontics, » and the other, which I would like to refer to as medical orthodontics.
The first focuses on aligning teeth without concerning itself with occlusion or functions, while the second takes functions into account—namely ventilation, swallowing, and mastication. The first could find justification in the results of studies that claim to be scientific and tend to show that occlusion has no link with temporo-mandibular joint dysfunctions. The second could be met with the argument that there is no evidence of the benefit of early treatments compared with late treatments.

Yet clinicians who are committed to this functional approach know the benefits they bring to their patients. They are convinced, like you and me, that helping patients to function is certainly the path of the future of orthodontics—if not that of the present. They know that their treatment will be more stable if they achieve functional harmonization, and that they will avoid extractions and surgical treatments.
The purpose of this presentation is to show that functional education does not stop at the masticatory sphere. It also plays a role in postural function, but postural function can in turn disrupt masticatory function, and it is desirable to take a global view of our patients. Look beyond the teeth, as advocated by the Bioprogressive approach.

Association of dysmorphoses: impacted canine, transposition, and biproalveolysis: application of minivis / F. HAÏM
The association of dysmorphoses is common in our specialty. It makes the development of the therapeutic plan more complex, which will have to take into account possible contingencies during certain phases of treatment. A re-evaluation may be necessary before deciding between different therapeutic alternatives, especially if they present an irreversible character, such as extractions of permanent teeth.
Orthodontic minivis make it possible to treat complex cases in which anchorage is of critical importance.
This clinical case report shows the possibilities for correcting a canine/lateral incisor transposition, the precautions to take to avoid worsening the rhyzalysis of the lateral incisor, and the contribution of anchorage minivis in cases requiring extreme anchorage.

Today’s obligations, a guarantee for tomorrow (3) / A. BÉRY
The number of obligations placed on the orthodontist as part of their professional practice continues to grow.
Not fulfilling them leaves the door open to potential disputes.
Knowing and applying them: these are, in a sense, the best ways to avoid unpleasant legal proceedings.
We continue our presentation on patient information.