For Young Patient with Deformities, the Gift of Straight Teeth

The 11-year-old patient had Treacher Collins Syndrome, a rare genetic condition that can cause severe facial deformities and an abnormally small jaw. Although the boy, “C.A.,’’ had several symptoms of the disease --  he couldn't close his mouth and had difficulty eating -- one bothered him most of all.

After treatment.

Before treatment.

“He said, ‘I have crooked teeth,''' recalls Dr. Thomas J. Cangialosi, RSDM chair of the Department of Orthodontics, whose case study was published last month in the American Journal of Orthodontics and Dentalfacial Orthopedics. When he treated C.A. from 2009 to 2011, he was a professor at the Columbia University School of Dental Medicine. C. A. had the smallest lower jaw Cangialosi and his team had ever seen, causing disfiguring crowding of his teeth.

After oral surgeons extracted four teeth, Cangialosi fitted him for braces, in addition to working with surgeons who lengthened his mandible and moved his chin forward. After three years of treatment, including “mini-implants,’’ temporary anchorage devices inserted into the bone between the roots of the teeth, the results were dramatic. C.A.'s teeth were straight, his speech improved, he could eat without problems, and he liked his smile, says Cangialosi.

About one in 50,000 people are born with Treacher Collins Syndrome, which is marked by features such as underdeveloped cheekbones, downward slanting eyes, and misshapen ears. Some have below average intelligence, but that wasn’t the case with C.A., whose low-income family couldn’t afford surgery and dental work. “What a great kid this was, so cooperative,’’ remembers Cangialosi. “We talked about basketball, how he was doing in school. He was a Yankees fan.’’

For Cangialosi, the results of C.A.'s treatment were especially rewarding. “You make no money treating a case like this. But I would rather treat ten of these patients than one kid that has a few crooked teeth,’’ he says. “It’s very gratifying.’’