[Pre-orthognathic surgery in orthodontics: towards justification]

This work presents long term results of rhinopharyngeal desobstructions on nine years old patients. By using several techniques such as: tonsillectomies, adenoïdectomy, adenoïdotonsillectomies, luxation of inferior turbinates, partial turbinectomies or bilateral turbinectomies under endoscopic guidance, and then, following carefully the oral and nasal peak flows for a period as long as one or two years, it becomes obvious that the most efficient desobstruction procedure is accomplished through a combination of E.N.T. rhinopharyngeal procedures, i.e. adenoïdotonsillectomies and inferior turbinectomies under endoscopic guidance. This global E.N.T. procedure is known as "Chimney Sweep". The author demonstrates that tongue behavior is severely affected by rhinopharyngeal obstruction and by the consecutive dysfunction of the upper airway ventilation pattern. Large tongues and normal tongues pushed forward due to enlarged tonsils or adenoïds are also affected by their necessary participation to oral ventilation (mouth breathers). Addition of a selective lingual glossoplasty or a partial glossectomy is sometimes necessary to put the morphogenic function in a proper order during growth and development. All of the above is part of a new pre-orthognathic concept, that helps control growth and development and helps manage orthodontic or orthognathic treatments.