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. 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 for any help you can give us,


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! He sounds like a real warrior. Due to your son’s age and unique concerns, orthodontics are likely a crucial component of his overall health and prognosis.

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. You’ll want to know if there are any surgeries planned in the near future? Might there be anything they may wish the dental office to know before seeing him? Once they give you the all-clear, you may call to schedule his initial exam. It will be helpful to provide them with the name and contact information of your son’s doctors and surgeons at this first appointment as well. 

Your Instincts Are Likely Correct

Next, it’s important to realize that not only will your son likely be able to have orthodontic treatment, it may be imperative that he do so. 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. We will know more once he is in the chair. 

Keeping His Mouth Impeccably Clean

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

When the teeth are aligned, the face may appear a bit more symmetrical as well, complementing the efforts of the facial plastic surgeon. His speech, if affected, may also see a slight improvement. 

He Has Options

Again, it’s difficult to determine without having him physically in the chair, but by your description it’s easy to infer: conventional braces may be a physical irritant, and perhaps not the best choice. The next option would be clear aligners, like Invisalign. These are smooth, flexible plastic pieces that are custom-fit to the patient’s mouth. Impressions or scans are taken of your son’s teeth, and a series of aligners are created. These are worn daily for as many hours as possible, only removed to eat, and changed weekly, slowly creating movement. This would avoid the use of metal bands, brackets or wires, and the aligners slim profile should be much better tolerated by the mucosa near the lesion. Most clear aligner treatment lengths are between 12 to 18 months, though with his particular need this may be longer. 

He Has A Great Team

Typically, we see best results with clear braces when patients are of sufficient maturity to assure compliance: continually wearing the aligners, keeping them and the mouth clean, and changing them at the regularly prescribed intervals. Your son is a bit younger than the usual start age, though with your continued assistance he can still look forward to a favorable result. Thank you for your sharp parenting.

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