Meazzini Maria Costanza, Zappia Laura B, Tortora Chiara, Autelitano Luca, Tintinelli Roberto
1 Department of Maxillo-Facial Surgery, Smile House, Regional Center for CLP, San Paolo Hospital, University of Milan, Milan, Italy.
2 San Paolo Hospital, University of Milan, Milan, Italy.
Cleft Palate Craniofac J. 2019 Feb;56(2):159-167. doi: 10.1177/1055665618772395. Epub 2018 Apr 27.
The objective of this retrospective longitudinal study was to evaluate short- and long-term results of the application of the Liou Alt-RAMEC (alternate rapid maxillary expansion and constriction) technique, a late orthopedic maxillary protraction technique, with intraoral anchorage, in patients with cleft.
Twenty-six patients with unilateral cleft lip and palate (UCLP) were consecutively treated with the Alt-RAMEC technique. The average age of the patients was 11.7 years (10.3-13.2 years) before protraction and 18.3 years (17.4-21.1 years) at long-term follow-up. A sample of nontreated patients with UCLP was used as a control group. It was matched for sex, skeletal class III, and age (11.3 years). The control sample had records at the end of growth (18.7 years).
The sagittal advancement of A-point, after the application of the technique, was 5.7 (2.17) mm. Some mandibular dentoalveolar and positional adaptation was noted. The position of the maxilla was stable in the long term. On the other hand, the UCLP control group showed hardly any growth at the maxillary level during the long-term follow-up period.
Our results showed that the Alt-RAMEC technique, performed at the correct time, with a double-hinged expander, followed by class III spring or elastic traction, 24 hours per day, allows for satisfactory maxillary protraction, with, at this stage, apparently stable long-term results. Nevertheless, as only 50% of the patients had long-term follow-up data, we are still unable to predict the percentage of patients which will not eventually need orthognathic surgery.
本回顾性纵向研究的目的是评估Liou Alt-RAMEC（交替快速上颌扩弓与缩窄）技术（一种晚期正畸上颌前牵引技术，采用口内支抗）在腭裂患者中的短期和长期效果。
连续26例单侧唇腭裂（UCLP）患者接受Alt-RAMEC技术治疗。患者牵引前的平均年龄为11.7岁（10.3 - 13.2岁），长期随访时为18.3岁（17.4 - 21.1岁）。选取一组未经治疗的UCLP患者作为对照组。对照组在性别、骨骼III类及年龄（11.3岁）方面进行匹配。对照组在生长结束时（18.7岁）有记录。
应用该技术后，A点矢状向前进5.7（2.17）mm。观察到下颌牙牙槽及位置有一定适应性变化。上颌位置长期稳定。另一方面，UCLP对照组在长期随访期间上颌几乎没有生长。
我们的结果表明，在正确时间采用双铰链扩弓器，随后每天24小时使用III类弹簧或弹性牵引进行Alt-RAMEC技术，可实现满意的上颌前牵引，现阶段长期效果明显稳定。然而，由于只有50%的患者有长期随访数据，我们仍无法预测最终无需正颌手术的患者比例。
