Rapid maxillary expansion in syndromic patient - case report

This case report demonstrates the successful use of intraoral distractor/hygenic rapid expander (HYRAX) for rapid maxillary expansion in anteroposterior direction with an adjunctive use of face mask therapy for anterior orthopedic traction of maxillary complex in a cleft patient with concave profile. The patient was a 13-year-old girl who reported with a chief complaint of backwardly positioned upper jaw and a severely forward positioned lower jaw. Therefore, a treatment was chosen in which acrylic bonded rapid maxillary expansion was done with tooth tissue borne intraoral distractor/HYRAX having a different activation schedule along with Dr Henri Petit facemask to treat maxillary retrognathism. As a result, crossbite got corrected and attained a positive jet with no bone loss in cleft area over a period of 5 months which was followed by fixed mechanotherapy achieving a well settled occlusion in 1 year. After completion of expansion and fixed mechanotherapy, ANB became +1 post-treatment which was −4 pretreatment. The prognathic profile was markedly improved by expansion and taking advantage of the remaining growth potential, thus minimizing the chances of surgery later in life. This provided a viable alternative to orthognathic surgery with good long-term stability.

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Assessment of Immediate Skeletal Changes after Alternate Rapid Maxillary Expansion and Constriction – A Case Report

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/604 ◽

2021 ◽

Vol 10 (34) ◽

pp. 2954-2959

Author(s):

Shilpa Venkatesh Pharande

Keyword(s):

Case Report ◽

Rapid Maxillary Expansion ◽

Class Iii ◽

Class Iii Malocclusion ◽

Maxillary Expansion ◽

Skeletal Class ◽

Posterior Crossbite ◽

Skeletal Changes ◽

Before And After ◽

Opening And Closing

The Alt-RAMEC protocol was introduced by Liou in the year 2005. It allows for sutural mobilisation by opening and closing the RME screw for 7-9 weeks. Maxillary protraction after the use of Alt-Ramec (alternate rapid maxillary expansion and contraction) protocol is an efficient method for early treatment of skeletal Class III malocclusion. This case report shows the results of using a hyrax bonded maxillary expander with the Alt-RAMEC protocol to treat a maxillary hypoplasia Class III malocclusion. A 12-year-old patient with skeletal class III malocclusion with anterior as well as the unilateral posterior crossbite was treated using this protocol. CBCT scans were taken before and after expansion. These CBCT scans were used for assessing and analysing the skeletal changes that have occurred after using the AltRamec protocol. The objective of this case report is to assess skeletal changes after using the Alt-RAMEC protocol.

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Orthodontic Treatment of a Cleft Palate Patient with Surgically Assisted Rapid Maxillary Expansion

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1996_033_0445_otoacp_2.3.co_2 ◽

1996 ◽

Vol 33 (5) ◽

pp. 445-449 ◽

Cited By ~ 5

Author(s):

Takafumi Susami ◽

Takayuki Kuroda ◽

Teruo Amagasa

Keyword(s):

Case Report ◽

Cleft Palate ◽

Orthodontic Treatment ◽

Rapid Maxillary Expansion ◽

Third Molars ◽

Maxillary Expansion ◽

Anterior Maxilla ◽

Posterior Crossbite ◽

Palate Patient ◽

Suture Opening

Some adult cleft palate patients show severe maxillary transverse contraction and posterior crossbite. This case report demonstrates successful surgical-orthodontic treatment of such a patient. Surgically assisted rapid maxillary expansion (SA-RME) was completed prior to comprehensive orthodontic treatment. The osteotomy was performed on both the buccal and lingual aspects of the posterior maxillary alveolus. A Hyrax-type maxillary-expansion appliance was used, and the screw (0.2 mm, one quarter turn) was turned two or three times per day. Comprehensive orthodontic treatment was initiated after extraction of the mandibular first premolars and four third molars. The maxillary lateral incisors were also extracted after active orthodontic treatment. The amount of expansion achieved using SA-RME was greater at the posterior than at the anterior maxilla. Midpalatal suture opening occurred. After orthodontic treatment, occlusal stability was satisfactory. This case demonstrates the effectiveness of SA-RME in adult cleft palate patients with severe posterior crossbite.

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