Theriot Family Dental

Son Born With Rare Facial Malformation. Is He Still A Candidate For Orthodontics?

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My son, 13, was born with a rare congenital birth defect called Lymphangioma. People used to call it Cystic Hygroma. I’d never even heard of it before he was born, and my husband and I have certainly had to do our research and learn a lot about it. Basically, it means there is an overgrowth of lymphatic tissue in his right cheek, consisting of both macro-cystic and micro-cystic lesions that periodically swell and fill with fluid. He’s had numerous surgeries throughout his life to correct this, over six major resections so far. He may need more revision in the future, as well. They said they’ll never really get all of it out. His face is still somewhat asymmetrical and is more puffy on that side, along with a visible, although faint, scar.

The weight of the lesion over time has caused a lot of crooked teeth and bite problems, so I know he needs braces. The problem I’m having though is that I can’t imagine how he’s going to comfortably tolerate it. The inner cheek has a bunch of bumpy superficial areas that get in the way of his bite, causing them to occasionally open, bleed, swell, and become quite infected. It seems like braces would continually tear this open and leave it even more prone to frequent infection. Do we have to wait until his surgeries are completed to pursue orthodontics? Are there any answers for him?

Thank you,


Dear Carmen,

girl smiling with braces You raise an important and tricky issue. That’s a lot for your son and your family to go through, indeed! He sounds like a real warrior.

Start With Clearance From His Medical Practitioners

First, check with your son’s pediatric plastic surgeon and general practitioner before proceeding. You’ll want to let them know your concerns about your son’s oral health, and that you’re planning to bring him in for a consultation. Verify that this is a good time to start orthodontics for him. Ask about the schedule for any upcoming surgeries. Is there anything the orthodontist would need to know beforehand? Once they give you the all-clear, you may call to schedule his initial exam.

Your Instincts Are Likely Correct

Next, it’s important to realize that your son will be able to have orthodontic treatment at some point. It’s difficult to assess through text, and he’ll need to come in for images and an exam before diagnosis, but it seems correcting the malocclusion may allow for the biting of the inner cheek to stop, which in turn should minimize the trauma and recurrent infections, allowing for healing. This is assuming the permanent teeth are all present and the palatal width is sufficient as well.

Correcting the bite should also allow for better oral hygiene as well, creating a much easier situation for accurate brushing and flossing. This will minimize the buildup of plaque, biofilm, and calculus. It will also contribute to a lower incidence of decay and oral infection. I’d continue to encourage the very best oral hygiene habits possible. 

Other Ways Orthodontic Treatment May Help

Based on your description, I would say traditional braces would not be the best option for him. The last thing he needs is a physical irritant. Instead, I’m going to suggest you look for someone who provides clear aligners instead of traditional braces. Two common brands of these are Invisalign and Clear Correct. These do not use the metal wires and brackets of traditional braces.

Your first order of business is getting the go-ahead.

This blog is brought to you by Lafayette, LA Dentist Dr. John Theriot.